Healthcare Provider Details

I. General information

NPI: 1649737115
Provider Name (Legal Business Name): KAYLA DAWN SMITH MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E POWELL BLVD
GRESHAM OR
97080-1365
US

IV. Provider business mailing address

1802 N PINE ST APT D300
CANBY OR
97013-4462
US

V. Phone/Fax

Practice location:
  • Phone: 503-699-4300
  • Fax:
Mailing address:
  • Phone: 503-413-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: