Provider Demographics
NPI:1629487681
Name:SCOTT, KATHRYN MARLENE (CADC I, CRM)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARLENE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CADC I, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16756
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0756
Mailing Address - Country:US
Mailing Address - Phone:971-386-3402
Mailing Address - Fax:503-208-2596
Practice Address - Street 1:704 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1842
Practice Address - Country:US
Practice Address - Phone:971-386-3402
Practice Address - Fax:503-208-2596
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OR17-CRM-030175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)