Individual
KELSEY ELIZABETH HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
304 PEARL ST, OREGON CITY, OR 97045-2684
(503) 657-9889
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
21-QMHA-R-1125
OR
225800000X
Recreation Therapist
67061
OR
Other
Enumeration date
04/29/2021
Last updated
04/29/2021
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