Provider Demographics
NPI:1780364109
Name:DAVIS, KATHERINE PAIGE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PAIGE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:PAIGE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA/ MED AID
Mailing Address - Street 1:1350 SE ANSPACH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2543
Mailing Address - Country:US
Mailing Address - Phone:971-261-8725
Mailing Address - Fax:
Practice Address - Street 1:1350 SE ANSPACH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97267-2543
Practice Address - Country:US
Practice Address - Phone:971-261-8725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor