Provider Demographics
NPI:1891929568
Name:ALBERTINA KERR
Entity Type:Organization
Organization Name:ALBERTINA KERR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SKILLS TRAINER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:EDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-255-4205
Mailing Address - Street 1:722 NE 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:722 NE 162ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5760
Practice Address - Country:US
Practice Address - Phone:503-255-4205
Practice Address - Fax:503-777-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health