Provider Demographics
NPI:1831704071
Name:ROSE, KYRAI IVY ANN (PHD)
Entity type:Individual
Prefix:
First Name:KYRAI
Middle Name:IVY ANN
Last Name:ROSE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 MONEDA AVE N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-6256
Mailing Address - Country:US
Mailing Address - Phone:859-200-8013
Mailing Address - Fax:541-314-9444
Practice Address - Street 1:147 COMMERCIAL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3416
Practice Address - Country:US
Practice Address - Phone:541-204-6292
Practice Address - Fax:541-314-9444
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health