Provider Demographics
NPI:1053604496
Name:BALDWIN, KATHERINE M (LMT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 SE 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2609
Mailing Address - Country:US
Mailing Address - Phone:503-888-8657
Mailing Address - Fax:
Practice Address - Street 1:5331 SW MACADAM AVE STE 285
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3849
Practice Address - Country:US
Practice Address - Phone:503-894-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist