Healthcare Provider Details

I. General information

NPI: 1558843029
Provider Name (Legal Business Name): KELSEY ALEXIS KUHLKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 S MACADAM AVE # 8021
PORTLAND OR
97239-6106
US

IV. Provider business mailing address

5441 S MACADAM AVE # 8021
PORTLAND OR
97239-6106
US

V. Phone/Fax

Practice location:
  • Phone: 503-825-0065
  • Fax: 503-894-7764
Mailing address:
  • Phone: 503-825-0065
  • Fax: 503-894-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: