Individual
KATY O'BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
911 SW 21ST AVE APT 303, PORTLAND, OR 97205-1567
(936) 581-2841
Mailing address
911 SW 21ST AVE APT 303, PORTLAND, OR 97205-1567
(936) 581-2841
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
525671
OR
Other
Enumeration date
07/07/2022
Last updated
07/07/2022
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