Provider Demographics
NPI:1578097218
Name:KEYS, ALICIA N (LMT #15489)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:N
Last Name:KEYS
Suffix:
Gender:F
Credentials:LMT #15489
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10480 SW EASTRIDGE ST APT 88
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5047
Mailing Address - Country:US
Mailing Address - Phone:503-384-9321
Mailing Address - Fax:
Practice Address - Street 1:10480 SW EASTRIDGE ST APT 88
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5047
Practice Address - Country:US
Practice Address - Phone:503-384-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist