Provider Demographics
NPI:1659189892
Name:KINOSHITA, YOKO
Entity type:Individual
Prefix:
First Name:YOKO
Middle Name:
Last Name:KINOSHITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YOKO
Other - Middle Name:KINOSHITA
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3855 LAKE GROVE AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4498
Mailing Address - Country:US
Mailing Address - Phone:503-688-3331
Mailing Address - Fax:
Practice Address - Street 1:3855 LAKE GROVE AVE APT 18
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4498
Practice Address - Country:US
Practice Address - Phone:503-688-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
ORA159011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker