Individual
KYLIE M LATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7104 SE TOLMAN ST, PORTLAND, OR 97206-6565
(323) 632-7735
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/12/2020
Last updated
12/12/2020
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