Provider Demographics
NPI:1811042195
Name:KAUFMANN, ELIZABETH RAE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:RAE
Last Name:KAUFMANN
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 1:635 SE 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2113
Mailing Address - Country:US
Mailing Address - Phone:503-887-1765
Mailing Address - Fax:503-653-5219
Practice Address - Street 1:10001 SE SUNNYSIDE RD STE 140
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5746
Practice Address - Country:US
Practice Address - Phone:503-887-1765
Practice Address - Fax:503-653-5219
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1659103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent