Provider Demographics
NPI:1982778312
Name:WOLFF, KELLIE OOSTERBAAN
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:OOSTERBAAN
Last Name:WOLFF
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:OOSTERBAAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:704 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1720
Mailing Address - Country:US
Mailing Address - Phone:541-386-6070
Mailing Address - Fax:541-610-1955
Practice Address - Street 1:704 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1720
Practice Address - Country:US
Practice Address - Phone:541-386-6070
Practice Address - Fax:541-610-1955
Is Sole Proprietor?:No
Enumeration Date:2006-11-18
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical