Provider Demographics
NPI:1770222440
Name:THIESEN, CATHERINE (MA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:THIESEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:THIESEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:4999 SE REGENTS CIR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4261
Mailing Address - Country:US
Mailing Address - Phone:503-908-5652
Mailing Address - Fax:
Practice Address - Street 1:225 NE 92ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220
Practice Address - Country:US
Practice Address - Phone:503-908-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health