Provider Demographics
NPI:1053359620
Name:KOHAMA, KATHLEEN ALBERTONI (MA-CCC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALBERTONI
Last Name:KOHAMA
Suffix:
Gender:F
Credentials:MA-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4084
Mailing Address - Country:US
Mailing Address - Phone:503-640-3147
Mailing Address - Fax:503-640-9753
Practice Address - Street 1:445 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4084
Practice Address - Country:US
Practice Address - Phone:503-640-3147
Practice Address - Fax:503-640-9753
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126024Medicaid