Individual
KASEY EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.M.
Contact information
Practice address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 593-7571
Mailing address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 593-7571
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568401347
—
OR
Enumeration date
01/09/2015
Last updated
01/09/2015
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