Provider Demographics
NPI:1669284030
Name:ROVO, KEITH ALEXANDER (CRM, PSS, THW)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALEXANDER
Last Name:ROVO
Suffix:
Gender:M
Credentials:CRM, PSS, THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 JACKSON ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-3244
Mailing Address - Country:US
Mailing Address - Phone:541-967-8545
Mailing Address - Fax:
Practice Address - Street 1:1100 JACKSON ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-3244
Practice Address - Country:US
Practice Address - Phone:541-967-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113076175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist