Doctor Name: | DR. KELLY JAYNE KALK |
NPI Number: | 1043588551 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.C. |
License Number: | |
Business Practice Address: | 700 Se Dowsett Ln Gresham, OR - 970807816 |
Business Phone Number: | 5039365098 |
Business Fax Number: | |
Mailing Address: | 700 Se Dowsett Ln, GRESHAM |
State: | OR |
Postal Code: | 970807816 |
Phone Number: | 5039365098 |
Fax Number: | |
NPI Enumeration Date: | 12/12/2011 |
NPI Last Update Date: | 05/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |