Kaitlin Elizabeth Park
Counselor in Portland, OR. Individual provider (NPI-1).
NPI number1164063954
StatusActive
Last updated in NPPESOct 2, 2019
Details
- NPI
- 1164063954
- Entity type
- Individual (NPI-1)
- Name
- Kaitlin Elizabeth Park
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 2, 2019
- Last updated
- Oct 2, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101Y00000X | Counselor | – | – | Yes |
Practice location
1904 Se Division StPortland, OR 97202-1146
Phone 503-517-8663
Mailing address
1904 Se Division StPortland, OR 97202-1146
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