Provider Demographics
NPI:1831447127
Name:GERSPACH, KATHI S (MA)
Entity type:Individual
Prefix:
First Name:KATHI
Middle Name:S
Last Name:GERSPACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SW MACADAM AVE.
Mailing Address - Street 2:SUITE 580
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:971-404-6603
Mailing Address - Fax:503-231-8153
Practice Address - Street 1:5200 SW MACADAM AVE
Practice Address - Street 2:SUITE 580
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:971-404-6603
Practice Address - Fax:503-231-8153
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR12644877OtherCAQH