Provider Demographics
NPI:1780242230
Name:POURJAFARI SEISAN, KAYLIE GRANLUND (CSWA, MSW)
Entity type:Individual
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First Name:KAYLIE
Middle Name:GRANLUND
Last Name:POURJAFARI SEISAN
Suffix:
Gender:F
Credentials:CSWA, MSW
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 NE BELKNAP CT STE 205
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5115
Mailing Address - Country:US
Mailing Address - Phone:503-560-5822
Mailing Address - Fax:
Practice Address - Street 1:8800 SE SUNNYSIDE RD STE 137S
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5770
Practice Address - Country:US
Practice Address - Phone:503-208-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator