Provider Demographics
NPI:1780251777
Name:KERWIN, TARA ANN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:KERWIN
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 1:200 SW MARKET ST STE 1650
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5739
Mailing Address - Country:US
Mailing Address - Phone:503-466-1668
Mailing Address - Fax:503-439-6194
Practice Address - Street 1:25050 SE STARK ST STE 300
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3388
Practice Address - Country:US
Practice Address - Phone:503-553-5930
Practice Address - Fax:503-667-0310
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1230801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical