Individual
KELLI JO SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
15691 SE ROYER RD, DAMASCUS, OR 97089-2642
(503) 658-7715
(503) 658-7181
Mailing address
3028 SE 28TH AVE, PORTLAND, OR 97202-2003
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
H3109
OR
171100000X
Acupuncturist
Primary
160456
OR
Other
Enumeration date
06/15/2013
Last updated
06/15/2013
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