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NPI Code Detail

MEDICARE: AMBER L KANALLAKAN

MEDICARE: AMBER L KANALLAKAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1396377990
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER L KANALLAKAN
Provider Business Mailing Address
First Line : 113 N ELM ST
Second Line :
City : CANBY
State : OR
Zip : 97013-3519
Country : US
Telephone Number : 503-263-8903
Fax Number : 503-266-8632
Provider Business Practice Location Address
First Line : 5291 NE ELAM YOUNG PKWY STE 160
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-7560
Country : US
Telephone Number : 503-372-5147
Fax Number : 503-650-4302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2020
Last Update Date : 11/17/2021

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