Katherine Coll Mabou
Individual provider Active NPI Speech-Language Pathologist · Fairview, OR
NPI 1962271817 · NPPES record last updated Sep 20, 2024
Key facts
- NPI
- 1962271817
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 18134 (OR)
- Practice address
- 1204 NE 201St Ave
Fairview, OR 97024-2499 - Phone
- (503) 661-7200
- NPI assigned
- Dec 20, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6524 | LA | MD | General Practice Dentistry |
| 18134 | OR | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 6524 | LA | |
| Speech-Language Pathologist | 235Z00000X | 18134 | OR | Yes |
Addresses
Primary practice location
1204 NE 201St Ave
Fairview, OR 97024-2499
Mailing address
1204 NE 201St Ave
Fairview, OR 97024-2499
Phone (503) 661-7200
Other providers in Fairview, OR
- Rebecca Leibham
- Toni Kachiri Lewis
- Alicia Loughlin
- Lara Loughlin
- Tammy Marie Lundbom
- Denise Maddock
- Naomi Ann Mandsager
- Juan Mata
- Samuel Mattingly
- Laurie Anne McAdam
All providers in Fairview, OR · Speech-Language Pathologist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.