Individual
TONEASHA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
421 SW OAK ST STE 520, PORTLAND, OR 97204-1810
(503) 360-2647
Mailing address
524 NE 52ND AVE, PORTLAND, OR 97213-3047
(503) 360-2647
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/11/2015
Last updated
11/11/2015
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