Individual
KRISTIN JOHNSON MASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
205 SE SPOKANE ST STE 358, PORTLAND, OR 97202-6494
(917) 370-2358
(917) 370-2358
Mailing address
6515 NE 22ND AVE, PORTLAND, OR 97211-5352
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4410
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L4410
CLINICAL SW LICENSE
OR
Enumeration date
09/11/2019
Last updated
03/19/2021
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