Individual
MRS. KATY LYNN GROSSKOPF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1516 SE 43RD AVE, PORTLAND, OR 97215-3112
(503) 307-3922
Mailing address
1516 SE 43RD AVE, PORTLAND, OR 97215-3112
(503) 307-3922
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12738
OR
Other
Enumeration date
05/01/2008
Last updated
05/01/2008
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