Provider Demographics
NPI:1821233214
Name:STORM, KELSIE JANELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELSIE
Middle Name:JANELLE
Last Name:STORM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELSIE
Other - Middle Name:JANELLE
Other - Last Name:BICKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:94 SE 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1437
Mailing Address - Country:US
Mailing Address - Phone:360-601-7326
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:MAIL CODE DC9R
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-13
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL17856208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics