# KARTINI CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134205198
- **Authorized official:** SHANNA GREENE (COO)
- **Authorized official phone:** (503) 249-8851

## Contact information

- **Practice address:** 3530 N VANCOUVER AVE STE 400, PORTLAND, OR 97227-1798
- **Practice address phone:** (503) 249-8851
- **Practice address fax:** (503) 282-3409
- **Mailing address:** 3530 N VANCOUVER AVE STE 400, PORTLAND, OR 97227-1798
- **Mailing address phone:** (503) 249-8851
- **Mailing address fax:** (503) 282-3409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | OR | — |
| 208000000X | Pediatrics Physician | — | OR | — |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | OR | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | OR | — |

## Other

- **Enumeration date:** 10/31/2006
- **Last updated:** 07/21/2022