Individual
MRS. STACEY MARLENE KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4400 NE HALSEY ST, PORTLAND, OR 97213-1545
(971) 263-3942
Mailing address
4204 SE 63RD AVE, PORTLAND, OR 97206-3767
(503) 819-8903
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7752
OR
Other
Enumeration date
07/21/2019
Last updated
11/27/2023
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