Individual
KYIRA WACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
2115 SE ADAMS ST STE B, MILWAUKIE, OR 97222
(503) 659-3480
Mailing address
8027 SE 49TH AVE, PORTLAND, OR 97206-0824
(414) 217-2985
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C5188
OR
Other
Enumeration date
08/02/2017
Last updated
02/12/2019
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