Individual
DR. KATIE B MCCULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5228 NE HOYT ST BLDG B2ND, PORTLAND, OR 97213-3055
(503) 215-4860
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
60690421
WA
103TC0700X
Clinical Psychologist
Primary
2976
OR
103TC0700X
Clinical Psychologist
60690421
WA
Other
Enumeration date
01/31/2017
Last updated
04/09/2019
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