Provider Demographics
NPI:1578570990
Name:DEAN, KELI JAYNE (PSYD)
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:JAYNE
Last Name:DEAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4044 NE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1323
Mailing Address - Country:US
Mailing Address - Phone:503-242-3521
Mailing Address - Fax:503-222-3741
Practice Address - Street 1:1020 SW TAYLOR ST
Practice Address - Street 2:SUITE 260
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2543
Practice Address - Country:US
Practice Address - Phone:503-242-3521
Practice Address - Fax:503-222-3741
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical