Individual
KELLY MAE NOWAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1073 OAK ST SE, SALEM, OR 97301-4018
(503) 585-4949
Mailing address
4372 THORMAN AVE NE, KEIZER, OR 97303-4652
(775) 800-3217
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/10/2018
Last updated
01/15/2019
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