Provider Demographics
NPI:1457599144
Name:KINABO, KERI ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:ANN
Last Name:KINABO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KERI
Other - Middle Name:ANN
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8749 N DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6905
Mailing Address - Country:US
Mailing Address - Phone:503-860-2470
Mailing Address - Fax:
Practice Address - Street 1:11010 SE DIVISION ST STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:503-335-5974
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health