Individual
TESSA ROSE SICOTTE-KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11261 NE KNOTT ST, PORTLAND, OR 97220-1704
(503) 253-8883
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/23/2025
Last updated
10/23/2025
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