Healthcare Provider Details

I. General information

NPI: 1699200311
Provider Name (Legal Business Name): LEAH MARIE KAUFFMAN QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20695 SW KINNAMAN RD
ALOHA OR
97078-1064
US

IV. Provider business mailing address

20695 SW KINNAMAN RD
ALOHA OR
97078-1064
US

V. Phone/Fax

Practice location:
  • Phone: 503-591-8371
  • Fax: 503-356-8327
Mailing address:
  • Phone: 503-591-8371
  • Fax: 503-356-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: