Healthcare Provider Details

I. General information

NPI: 1477178721
Provider Name (Legal Business Name): KAELYN ROSE LINDSAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SE 2ND ST
PENDLETON OR
97801-2224
US

IV. Provider business mailing address

PO BOX 469
HEPPNER OR
97836-0469
US

V. Phone/Fax

Practice location:
  • Phone: 541-240-8030
  • Fax:
Mailing address:
  • Phone: 541-676-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: