Provider Information for 1487782553
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KELLY L GOODMAN MSW
Sex: Female
NPI: 1487782553
Last Updated: 2009-12-11
Certification Date:
Certification Date:
Details
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NPI | 1487782553 | ||||||||
Enumeration Date | 2007-03-01 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 426 SW STARK ST 8TH FLOOR PORTLAND, OR 97204-2347 United States Phone: 503-988-3674 | Fax:503-988-5180 | ||||||||
Primary Practice Address | 421 SW OAK ST 210 PORTLAND, OR 97204-1817 United States Phone: 503-988-3674 | Fax:503-988-5180 | ||||||||
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