Provider Demographics
NPI:1780825265
Name:CLOUD, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CLOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 NE SAVANNAH DR STE 5
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4866
Mailing Address - Country:US
Mailing Address - Phone:541-382-0000
Mailing Address - Fax:
Practice Address - Street 1:568 NE SAVANNAH DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4866
Practice Address - Country:US
Practice Address - Phone:541-382-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist