Provider Demographics
NPI:1154078442
Name:SCOTT, KAYLEN ANNMARIE (PWS,CRM)
Entity type:Individual
Prefix:
First Name:KAYLEN
Middle Name:ANNMARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PWS,CRM
Other - Prefix:
Other - First Name:KAYLEN
Other - Middle Name:ANNMARIE
Other - Last Name:BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PWS,CRM
Mailing Address - Street 1:211 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4502
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:971-260-0355
Practice Address - Street 1:355 NW DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5523
Practice Address - Country:US
Practice Address - Phone:971-225-6695
Practice Address - Fax:503-231-1654
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
OR22-CRM-1000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist