Healthcare Provider Details

I. General information

NPI: 1760783393
Provider Name (Legal Business Name): ARLO RYAN-KEOHANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 SE INTERNATIONAL WAY 501
MILWAUKIE OR
97222-8855
US

IV. Provider business mailing address

14600 NW CORNELL RD
PORTLAND OR
97229-5442
US

V. Phone/Fax

Practice location:
  • Phone: 503-496-3201
  • Fax:
Mailing address:
  • Phone: 503-645-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: