Doctor Name: | KELLY BLIXHAVN |
NPI Number: | 1013234525 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 2051 Kaen Rd Suite 367 Oregon City, OR - 970454035 |
Business Phone Number: | 5037425335 |
Business Fax Number: | 5037425304 |
Mailing Address: | 2051 Kaen Rd, Suite 367 OREGON CITY |
State: | OR |
Postal Code: | 970454035 |
Phone Number: | 5037425335 |
Fax Number: | 5037425304 |
NPI Enumeration Date: | 04/23/2010 |
NPI Last Update Date: | 04/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |