Individual
KELSEY LEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1975 NW 167TH PL # 53, BEAVERTON, OR 97006-4908
(503) 730-2973
Mailing address
1975 NW 167TH PL # 53, BEAVERTON, OR 97006-4908
(503) 730-2973
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
BAP-E-10258397
OR
Other
Enumeration date
08/18/2025
Last updated
08/18/2025
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