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NPI Code Detail

MEDICARE: KEEDEHN HAUSS CADC II

MEDICARE: KEEDEHN HAUSS CADC II
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1831574235
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEEDEHN HAUSS CADC II
Provider Business Mailing Address
First Line : 2720 NE FLANDERS ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-3160
Country : US
Telephone Number : 503-238-5203
Fax Number :
Provider Business Practice Location Address
First Line : 2720 NE FLANDERS ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-3160
Country : US
Telephone Number : 503-238-5203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2015
Last Update Date : 09/28/2021

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