Provider Demographics
NPI:1780039321
Name:KEAM, ROSARIESOTHEA
Entity Type:Individual
Prefix:
First Name:ROSARIESOTHEA
Middle Name:
Last Name:KEAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 STATE ST STE 455
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3581
Mailing Address - Country:US
Mailing Address - Phone:503-383-1382
Mailing Address - Fax:
Practice Address - Street 1:388 STATE ST STE 455
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3581
Practice Address - Country:US
Practice Address - Phone:503-383-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist