Individual
KELLY AMANDA IRISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5859 SE 92ND AVE APT 204, PORTLAND, OR 97266-4663
(541) 731-3452
Mailing address
5859 SE 92ND AVE APT 204, PORTLAND, OR 97266-4663
(541) 731-3452
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
A4109
OR
Other
Enumeration date
03/22/2022
Last updated
03/22/2022
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