Provider Demographics
NPI:1689229007
Name:KIEVSKY, IAEL (MA)
Entity Type:Individual
Prefix:
First Name:IAEL
Middle Name:
Last Name:KIEVSKY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 N ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4021
Mailing Address - Country:US
Mailing Address - Phone:617-504-7899
Mailing Address - Fax:
Practice Address - Street 1:9201 SE FOSTER RD STE 206
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-4644
Practice Address - Country:US
Practice Address - Phone:971-252-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6782101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor