Provider Demographics
NPI:1275249583
Name:KERR, MANOLA APRIL
Entity Type:Individual
Prefix:
First Name:MANOLA
Middle Name:APRIL
Last Name:KERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8017 SE 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-9601
Mailing Address - Country:US
Mailing Address - Phone:541-829-9162
Mailing Address - Fax:
Practice Address - Street 1:8017 SE 64TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-9601
Practice Address - Country:US
Practice Address - Phone:541-829-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL10484104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker