Provider Demographics
NPI:1609671593
Name:KACIN, FEN THOMAS (PWS)
Entity type:Individual
Prefix:
First Name:FEN
Middle Name:THOMAS
Last Name:KACIN
Suffix:
Gender:M
Credentials:PWS
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:SOPHIA
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2410 SE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4624
Mailing Address - Country:US
Mailing Address - Phone:503-383-9643
Mailing Address - Fax:503-214-5545
Practice Address - Street 1:2410 SE 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4624
Practice Address - Country:US
Practice Address - Phone:503-383-9643
Practice Address - Fax:503-214-5545
Is Sole Proprietor?:No
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113107175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist