| Katie Ugolini PhD LLC | |
|
16110 Sw Regatta Ln Beaverton OR 97006-8942 | |
| (503) 617-6810 | |
| (503) 536-6794 |
| Full Name | Katie Ugolini PhD LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 16110 Sw Regatta Ln, Beaverton, Oregon |
| Authorized Official Name and Position | Kathleen Anne Ugolini (OWNER) |
| Authorized Official Contact | 5036176810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Katie Ugolini PhD LLC 5620 Ne 25th Ave Portland OR 97211-6106 Ph: (503) 449-9690 | Katie Ugolini PhD LLC 16110 Sw Regatta Ln Beaverton OR 97006-8942 Ph: (503) 617-6810 |
| NPI Number | 1164131603 |
|---|---|
| Provider Enumeration Date | 11/22/2022 |
| Last Update Date | 11/22/2022 |
| Certification Date | 11/22/2022 |
| Medicare PECOS PAC ID | 1052782877 |
|---|---|
| Medicare Enrollment ID | O20230113001261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164131603 | NPI | - | NPPES |
| 1346267184 | Other | OR | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (NU) | Primary |
| Provider Name | Katie a Ugolini |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346267184 PECOS PAC ID: 4981685252 Enrollment ID: I20040525000492 |
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