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General NPI Number Information
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NPI Number | 1023974433
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Entity Type | Individual
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Provider Name | KETEMA GELANEW DADI SR.
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Gender | Male
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 1107 NW 15TH ST APT 138
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City | GRESHAM
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State | OR
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Zip | 97030-4886
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Country | US
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Telephone | 408-655-1393
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 NW 15TH ST APT 138
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City | GRESHAM
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State | OR
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Zip | 97030-4886
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Country | US
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Telephone | 408-655-1393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | E237184
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License Number State | OR
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