Provider Demographics
NPI:1942748108
Name:MACKAY, KELLI (MSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MACKAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:JEANNE MACKAY
Other - Last Name:DOLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:9830 NE CASCADES PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-6832
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:503-262-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker