Provider Demographics
NPI:1942925243
Name:WESEMANN, KATIE SUE (CADC-R)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SUE
Last Name:WESEMANN
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10765 SW GREENBURG RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5413
Mailing Address - Country:US
Mailing Address - Phone:150-394-1856
Mailing Address - Fax:503-598-0934
Practice Address - Street 1:10765 SW GREENBURG RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5413
Practice Address - Country:US
Practice Address - Phone:503-684-8159
Practice Address - Fax:503-598-0934
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-22-2051101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)