Provider Demographics
NPI:1982040093
Name:BIESANZ, KATJA (LPC)
Entity Type:Individual
Prefix:
First Name:KATJA
Middle Name:
Last Name:BIESANZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 NE 12TH AVE
Mailing Address - Street 2:#201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2752
Mailing Address - Country:US
Mailing Address - Phone:503-703-1262
Mailing Address - Fax:503-232-7440
Practice Address - Street 1:407 NE 12TH AVE
Practice Address - Street 2:#201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2752
Practice Address - Country:US
Practice Address - Phone:503-703-1262
Practice Address - Fax:503-232-7440
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional