Provider Demographics
NPI:1639342082
Name:KARALEE KISER MSW LCSW PC
Entity Type:Organization
Organization Name:KARALEE KISER MSW LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KARALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:503-228-4124
Mailing Address - Street 1:5331 SW MACADAM AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6104
Mailing Address - Country:US
Mailing Address - Phone:503-228-4124
Mailing Address - Fax:502-228-4124
Practice Address - Street 1:5331 SW MACADAM AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6104
Practice Address - Country:US
Practice Address - Phone:503-228-4124
Practice Address - Fax:502-228-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#557251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13352Medicare PIN