Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2245 | OR |
N | 103T00000X | Psychologist | 2245 | OR |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 2245 | OR |
NPI | 1114259546 |
---|---|
Provider Name | Kristen Lauren Mackiewicz Seghete |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2010 |
Last Update Date | 04/04/2013 |