Provider Demographics
NPI:1669500914
Name:REAMS, KELLY ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:REAMS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 NE 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-5405
Mailing Address - Country:US
Mailing Address - Phone:503-224-1288
Mailing Address - Fax:503-274-2327
Practice Address - Street 1:2106 NE 40TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5405
Practice Address - Country:US
Practice Address - Phone:503-224-1288
Practice Address - Fax:503-274-2327
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical