Healthcare Provider Details

I. General information

NPI: 1104733807
Provider Name (Legal Business Name): ASH KREIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 SE DIVISION ST STE 115
PORTLAND OR
97202-1085
US

IV. Provider business mailing address

1235 SE DIVISION ST STE 115
PORTLAND OR
97202-1085
US

V. Phone/Fax

Practice location:
  • Phone: 719-352-2243
  • Fax:
Mailing address:
  • Phone: 719-352-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE-10274750
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: