Individual
KELLY LANDRETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4400 NE HALSEY ST BLDG 2 THIRD FLOOR, PORTLAND, OR 97213
(503) 893-6472
Mailing address
2121 NW RALEIGH ST APT 647, PORTLAND, OR 97210-2149
(503) 421-1434
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172V00000X
—
OR
Enumeration date
01/04/2021
Last updated
01/04/2021
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