Provider Demographics
NPI:1073334116
Name:STOGNER, KATIE L
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:STOGNER
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 1:1910 NW PETTYGROVE ST APT 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1623
Mailing Address - Country:US
Mailing Address - Phone:480-645-4637
Mailing Address - Fax:
Practice Address - Street 1:12734 SE MILL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1326
Practice Address - Country:US
Practice Address - Phone:503-924-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health