Provider Demographics
NPI:1194744656
Name:AYERS, KATHRYN E (MSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:AYERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21000 NW QUATAMA RD
Mailing Address - Street 2:UNIT 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-1410
Mailing Address - Country:US
Mailing Address - Phone:503-430-8136
Mailing Address - Fax:503-644-0379
Practice Address - Street 1:14195 SW MILLIKAN WAY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2307
Practice Address - Country:US
Practice Address - Phone:503-646-5687
Practice Address - Fax:503-644-0379
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORL40211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health