Provider Demographics
NPI:1033401674
Name:LINN, KEITH IAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:IAN
Last Name:LINN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NW LOVEJOY
Mailing Address - Street 2:STE. 401
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2865
Mailing Address - Country:US
Mailing Address - Phone:503-222-5212
Mailing Address - Fax:502-227-5796
Practice Address - Street 1:2525 NW LOVEJOY
Practice Address - Street 2:STE. 401
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2865
Practice Address - Country:US
Practice Address - Phone:503-227-6568
Practice Address - Fax:502-227-5796
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1504103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service