Basic Information
| Provider Information | |||||||||
| NPI: | 1346267184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UGOLINI | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 42510 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972420510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039631290 | ||||||||
| FaxNumber: | 5032301541 | ||||||||
| Practice Location | |||||||||
| Address1: | 15985 NW SCHENDEL AVE STE 230 | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970066734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036176810 | ||||||||
| FaxNumber: | 5035334433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1403 | OR | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 293389 | 01 | VALUE OPTIONS | OTHER |