Provider Demographics
NPI:1750490462
Name:MOREE, KEITH EDWARD (MS)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:EDWARD
Last Name:MOREE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 N INTERSTATE AVE
Mailing Address - Street 2:ATTN: SPEECH
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1106
Mailing Address - Country:US
Mailing Address - Phone:503-249-3326
Mailing Address - Fax:503-331-3061
Practice Address - Street 1:3600 N INTERSTATE AVE
Practice Address - Street 2:ATTN: SPEECH
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1106
Practice Address - Country:US
Practice Address - Phone:503-249-3326
Practice Address - Fax:503-331-3061
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist