Provider Demographics
NPI:1427101468
Name:CANNING, KATHY ANN (MA,LMFT)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:CANNING
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:355 GREENACRE DR NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-4208
Mailing Address - Country:US
Mailing Address - Phone:503-371-0685
Mailing Address - Fax:503-371-0685
Practice Address - Street 1:1320 EDGEWATER ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4095
Practice Address - Country:US
Practice Address - Phone:503-362-4229
Practice Address - Fax:503-371-0685
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTO141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist