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NPI Code Detail

MEDICARE: KELLY DEGRAAF

MEDICARE: KELLY DEGRAAF
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1558835470
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY DEGRAAF
Provider Business Mailing Address
First Line : 1750 NEBRASKA AVE BLDG A
Second Line :
City : GRANTS PASS
State : OR
Zip : 97527-5700
Country : US
Telephone Number : 541-956-4943
Fax Number :
Provider Business Practice Location Address
First Line : 4385 SUNNYVIEW RD NE
Second Line :
City : SALEM
State : OR
Zip : 97305-1869
Country : US
Telephone Number : 503-400-3340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2019
Last Update Date : 01/14/2019

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Directions to “ KELLY DEGRAAF ” Practice Location

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