Healthcare Provider Details

I. General information

NPI: 1760275234
Provider Name (Legal Business Name): KAYLEE ZIPPERER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 SW GREENBURG RD STE 210
TIGARD OR
97223-6464
US

IV. Provider business mailing address

1229 N CREEKSIDE LN
NEWBERG OR
97132-5605
US

V. Phone/Fax

Practice location:
  • Phone: 971-264-0952
  • Fax: 971-266-4521
Mailing address:
  • Phone: 920-323-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: