Provider Demographics
NPI:1871692509
Name:ROLF, KELLY LYNN (MSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:ROLF
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2626 NE 16TH AVE
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4232
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:360-759-1697
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:V3NSCU
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:360-696-4061
Practice Address - Fax:360-759-1697
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker