Provider Demographics
NPI:1710248851
Name:FISHER, KELSEY ALICE (MSM, LDM, CPM)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ALICE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSM, LDM, CPM
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ALICE
Other - Last Name:HANRAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5557 NE GOING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2630
Mailing Address - Country:US
Mailing Address - Phone:971-808-2864
Mailing Address - Fax:971-999-7000
Practice Address - Street 1:5557 NE GOING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2630
Practice Address - Country:US
Practice Address - Phone:971-808-2864
Practice Address - Fax:971-999-7000
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10165673176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife