Healthcare Provider Details

I. General information

NPI: 1114398690
Provider Name (Legal Business Name): KELLYN ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 NW FLANDERS ST SUITE 101
PORTLAND OR
97210
US

IV. Provider business mailing address

2330 NW FLANDERS ST SUITE 101
PORTLAND OR
97210
US

V. Phone/Fax

Practice location:
  • Phone: 503-701-8766
  • Fax: 503-241-5484
Mailing address:
  • Phone: 503-701-8766
  • Fax: 503-241-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number3024
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: