Individual
KELLIE SUPRIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
2931 NE BROADWAY ST, PORTLAND, OR 97232-1760
(503) 939-9482
Mailing address
2931 NE BROADWAY ST, PORTLAND, OR 97232-1760
(503) 939-9482
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C3491
OR
Other
Enumeration date
03/05/2013
Last updated
07/09/2024
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