Provider Demographics
NPI:1881996536
Name:SCHROEDER-BUSH, KATHLEEN YVONNE (LMT, CA)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:YVONNE
Last Name:SCHROEDER-BUSH
Suffix:
Gender:F
Credentials:LMT, CA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:YVONNE
Other - Last Name:SWANBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, CA
Mailing Address - Street 1:12795 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5300
Mailing Address - Country:US
Mailing Address - Phone:503-641-4244
Mailing Address - Fax:
Practice Address - Street 1:12795 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97229-5300
Practice Address - Country:US
Practice Address - Phone:503-641-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist