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NPI Code Detail

MEDICARE: KELI JAYNE DEAN PSY.D.

MEDICARE:   KELI JAYNE DEAN  PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1682OR

General Provider Information

NPI Number : 1578570990
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELI JAYNE DEAN PSY.D.
Provider Business Mailing Address
First Line : 4044 NE 15TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97212-1323
Country : US
Telephone Number : 503-242-3521
Fax Number : 503-222-3741
Provider Business Practice Location Address
First Line : 1020 SW TAYLOR ST
Second Line : SUITE 260
City : PORTLAND
State : OR
Zip : 97205-2543
Country : US
Telephone Number : 503-242-3521
Fax Number : 503-222-3741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 07/08/2007

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Directions to “ KELI JAYNE DEAN PSY.D.” Practice Location

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