Provider Demographics
NPI:1568186195
Name:MAYO-HUDSON, KATHRYN VIRGINIA (MSW, CSWA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:VIRGINIA
Last Name:MAYO-HUDSON
Suffix:
Gender:F
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 NE 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2919
Mailing Address - Country:US
Mailing Address - Phone:503-806-9235
Mailing Address - Fax:
Practice Address - Street 1:7105 SW VARNS ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8148
Practice Address - Country:US
Practice Address - Phone:503-806-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORA15753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program