Individual
KELLY ANNE MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1404 NE 134TH ST STE 290, VANCOUVER, WA 98685-2799
(360) 606-9099
Mailing address
PO BOX 56572, PORTLAND, OR 97238-6572
(360) 606-9099
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LF70068506
WA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/26/2022
Last updated
03/14/2026
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