Provider Demographics
NPI:1841503315
Name:BRANDT, KATHRYN EILEEN (MS, CFY-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:EILEEN
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:MRS
Other - First Name:KATAHRYN
Other - Middle Name:EILEEN
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CFY-SLP
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5203
Practice Address - Street 1:1577 SOUTH IVY ST.
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013
Practice Address - Country:US
Practice Address - Phone:503-266-5541
Practice Address - Fax:503-266-5544
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR013364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist