Provider Demographics
NPI:1245218569
Name:KELLER, KORY LEIGH (MS)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:LEIGH
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5244 SW BANCROFT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2040
Mailing Address - Country:US
Mailing Address - Phone:503-494-2775
Mailing Address - Fax:503-494-2786
Practice Address - Street 1:707 SW GAINES ST
Practice Address - Street 2:OHSU GENETICS
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2901
Practice Address - Country:US
Practice Address - Phone:503-494-2775
Practice Address - Fax:503-494-2786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS