1598257859 NPI number — DR. KATHLEEN CHANDRA MAWSON AUD

Table of content: WHITNEY E MARVIN P.A. (NPI 1952735896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598257859 NPI number — DR. KATHLEEN CHANDRA MAWSON AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAWSON
Provider First Name:
KATHLEEN
Provider Middle Name:
CHANDRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAWSON
Provider Other First Name:
KATY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AU.D., CCC-A, FAAA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598257859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 SE 7TH AVE STE 4150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97123-4157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-352-2661
Provider Business Mailing Address Fax Number:
503-924-6704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 SE 7TH AVE STE 4150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97123-4157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-352-2661
Provider Business Practice Location Address Fax Number:
503-924-6704
Provider Enumeration Date:
06/03/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  030912 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500751002 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".