Provider Demographics
NPI:1063111441
Name:MOSHINSKY, KATHLEEN ANNE
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:MOSHINSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 SW HUNZIKER RD STE 215
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2304
Mailing Address - Country:US
Mailing Address - Phone:503-778-0787
Mailing Address - Fax:
Practice Address - Street 1:7340 SW HUNZIKER RD STE 215
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2304
Practice Address - Country:US
Practice Address - Phone:503-778-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty