MEDICARE: MS. KELLY GOFORTH M.ED.

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
1	101YS0200X	School Counselor	501998	OR

General Provider Information

NPI Number	:	1689552416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY GOFORTH M.ED.

Provider Business Mailing Address
First Line	:	6941 N CENTRAL ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-6299
Country	:	US
Telephone Number	:	503-916-5260
Fax Number	:

Provider Business Practice Location Address
First Line	:	6941 N CENTRAL ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-6299
Country	:	US
Telephone Number	:	503-916-5260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	08/21/2025

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Directions to “ MS. KELLY GOFORTH M.ED.” Practice Location

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