Individual
KRISTINE CAVANAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, CADC I
Contact information
Practice address
1007 NE BROADWAY ST STE 220, PORTLAND, OR 97232-1284
(503) 998-5727
Mailing address
1007 NE BROADWAY ST STE 220, PORTLAND, OR 97232-1284
(503) 998-5727
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C2116
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C2116
OCLPCT
OR
Enumeration date
05/17/2007
Last updated
03/15/2016
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