Provider Demographics
NPI:1518479146
Name:KEHDI, NORMA KEHDI
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:KEHDI
Last Name:KEHDI
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 1:3115 DUANE AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-7366
Mailing Address - Country:US
Mailing Address - Phone:503-516-7832
Mailing Address - Fax:
Practice Address - Street 1:2225 PACIFIC BLVD SE STE 108
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-7903
Practice Address - Country:US
Practice Address - Phone:503-877-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-05
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3653103TC0700X
CA29158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty