Provider Demographics
NPI:1306301585
Name:BROWN, KATIE LYNN (MSCN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15469 NW WHITE FOX DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5660
Mailing Address - Country:US
Mailing Address - Phone:503-577-9370
Mailing Address - Fax:
Practice Address - Street 1:16679 BOONES FERRY RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4378
Practice Address - Country:US
Practice Address - Phone:503-635-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst