Landreth, Kelly
Landreth, Kelly is an sole proprietor health care provider with primary practice located at 4400 Ne Halsey St Bldg 2 Third Floor , Portland OR 97213. She recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as her primary health care specialty. Landreth, Kelly can be contacted via phone (503) 893-6472.Contact Information
Primary practice address
4400 Ne Halsey St Bldg 2 Third Floor
Portland OR 97213
Phone: (503) 893-6472
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Community Health Worker | 172V00000X | Oregon |
Profile Details
| NPI number | 1922696202 |
|---|---|
| LBN Legal business name | Landreth, Kelly |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 4th, 2021 |
| Last updated | Jan 4th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922696202 | NPPES |
| Oregon | MEDICAID | 172V00000X |
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