Provider Demographics
NPI:1487752382
Name:CHIBA, KATHERINE L (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:L
Last Name:CHIBA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:CHIBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1222 NE 195TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-7737
Mailing Address - Country:US
Mailing Address - Phone:503-816-1808
Mailing Address - Fax:503-386-2176
Practice Address - Street 1:811 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1231
Practice Address - Country:US
Practice Address - Phone:503-816-1808
Practice Address - Fax:503-386-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL38481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical