Provider Demographics
NPI:1255571352
Name:GEHRKE, CARLEE MICHELLE
Entity type:Individual
Prefix:MISS
First Name:CARLEE
Middle Name:MICHELLE
Last Name:GEHRKE
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 1:13020 SW CREEKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5726
Mailing Address - Country:US
Mailing Address - Phone:503-200-0557
Mailing Address - Fax:
Practice Address - Street 1:15282 SW TEAL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8129
Practice Address - Country:US
Practice Address - Phone:503-200-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12793225700000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor