Basic Information
| Provider Information | |||||||||
| NPI: | 1790164119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOOVER | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 SE ALIKA AVE | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971235200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362662066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4585 SW 185TH AVE | ||||||||
| Address2: | |||||||||
| City: | ALOHA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970781557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035919280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2015 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 283234 | 05 | OR | MEDICAID |