Provider Demographics
NPI:1922473073
Name:SIMPSON, K'LYNN
Entity Type:Individual
Prefix:
First Name:K'LYNN
Middle Name:
Last Name:SIMPSON
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 1:9430 SW CORAL ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6691
Mailing Address - Country:US
Mailing Address - Phone:503-644-1418
Mailing Address - Fax:503-644-1422
Practice Address - Street 1:9430 SW CORAL ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6691
Practice Address - Country:US
Practice Address - Phone:503-644-1418
Practice Address - Fax:503-644-1422
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist