Provider Demographics
NPI:1699851832
Name:COMMERFORD, KATHLEEN ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANNE
Last Name:COMMERFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 NE 44TH AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1443
Mailing Address - Country:US
Mailing Address - Phone:503-249-1350
Mailing Address - Fax:503-284-0792
Practice Address - Street 1:1827 NE 44TH AVE
Practice Address - Street 2:STE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1443
Practice Address - Country:US
Practice Address - Phone:503-249-1350
Practice Address - Fax:503-284-0792
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR711103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0000TCHCTMedicare ID - Type Unspecified