Provider Demographics
NPI:1730268277
Name:LEOPOLD, KAYLA MARY (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:MARY
Last Name:LEOPOLD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 SW BERTHA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2039
Mailing Address - Country:US
Mailing Address - Phone:503-860-0656
Mailing Address - Fax:503-245-3118
Practice Address - Street 1:1306 SW BERTHA BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2039
Practice Address - Country:US
Practice Address - Phone:503-860-0656
Practice Address - Fax:503-245-3118
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical