Provider Demographics
NPI:1699828020
Name:HERNANDEZ, KAREN (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 SW 2ND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2778
Mailing Address - Country:US
Mailing Address - Phone:503-803-9530
Mailing Address - Fax:503-642-3179
Practice Address - Street 1:12750 SW 2ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2778
Practice Address - Country:US
Practice Address - Phone:503-803-9530
Practice Address - Fax:503-642-3179
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1596103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029142Medicaid