Individual
KAYLA COLVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSS, CRM
Contact information
Practice address
2720 NE FLANDERS ST, PORTLAND, OR 97232-3160
(503) 238-5203
Mailing address
10621 SE LINWOOD AVE, MILWAUKIE, OR 97222-2710
(541) 217-1609
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10-CRM-290
MHACBO
OR
01
—
THW000004102
TRADITIONAL HEALTH WORKER, STATE OF OREGON
OR
Enumeration date
07/14/2020
Last updated
07/14/2020
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