Individual
KATHLEEN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSWA
Contact information
Practice address
7700 SW GARDEN HOME RD APT 23, PORTLAND, OR 97223-7496
(503) 572-9340
Mailing address
4931 SW 76TH AVE # 128, PORTLAND, OR 97225-1805
(503) 572-9340
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
A5050
OR
Other
Enumeration date
10/31/2020
Last updated
10/31/2020
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