Provider Demographics
NPI:1740419936
Name:KEYSER, MICHELLE M (MICHELLE KEYSER)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:KEYSER
Suffix:
Gender:F
Credentials:MICHELLE KEYSER
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:GLUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8383 NE SANDY BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4967
Mailing Address - Country:US
Mailing Address - Phone:503-253-0964
Mailing Address - Fax:
Practice Address - Street 1:8383 NE SANDY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4967
Practice Address - Country:US
Practice Address - Phone:503-253-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical