Provider Demographics
NPI:1700193612
Name:KAUFFMAN, KATHERINE J (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:KAUFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:3620 SE POWELL BLVD # 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1880
Mailing Address - Country:US
Mailing Address - Phone:503-486-8936
Mailing Address - Fax:503-894-6020
Practice Address - Street 1:3620 SE POWELL BLVD # 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1880
Practice Address - Country:US
Practice Address - Phone:503-486-8936
Practice Address - Fax:503-894-6020
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3371101YM0800X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500717457Medicaid