Provider Demographics
NPI:1538436324
Name:ST CLAIR, KEELEY SWETE (MT-BC)
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:SWETE
Last Name:ST CLAIR
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 SE 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5215
Mailing Address - Country:US
Mailing Address - Phone:541-520-1477
Mailing Address - Fax:
Practice Address - Street 1:5911 SE 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5215
Practice Address - Country:US
Practice Address - Phone:541-520-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10053225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist