Individual
KATHERINE M VAN DE COEVERING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN/QMHP
Contact information
Practice address
12360 E BURNSIDE ST, PORTLAND, OR 97233-1042
(971) 279-4800
(971) 279-2051
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
OR
163W00000X
Registered Nurse
Primary
201608013RN
OR
163W00000X
Registered Nurse
RN61311920
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500805925
—
OR
Enumeration date
04/19/2022
Last updated
07/17/2023
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