Provider Demographics
NPI:1295343473
Name:COLVIN, KAYLA (PSS, CRM)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:COLVIN
Suffix:
Gender:F
Credentials:PSS, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 SE LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2710
Mailing Address - Country:US
Mailing Address - Phone:541-217-1609
Mailing Address - Fax:
Practice Address - Street 1:2720 NE FLANDERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3160
Practice Address - Country:US
Practice Address - Phone:503-238-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000004102OtherTRADITIONAL HEALTH WORKER, STATE OF OREGON
OR10-CRM-290OtherMHACBO