Healthcare Provider Details

I. General information

NPI: 1740463066
Provider Name (Legal Business Name): LINDA KEELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9111 NE SUNDERLAND AVE
PORTLAND OR
97211-1708
US

IV. Provider business mailing address

3533 SE MONROE ST APT 38
MILWAUKIE OR
97222-6560
US

V. Phone/Fax

Practice location:
  • Phone: 503-280-6646
  • Fax:
Mailing address:
  • Phone: 503-653-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: