Individual ProviderKeli Mikal CannonCounselorBehavioral Health & Social Service ProvidersPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553(503) 258-4200PECOS EnrollmentBased on the most recent information from CMS, provider Keli Mikal Cannon does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1508232356Provider TypeIndividualFull NameCannon, Keli MikalGenderFemaleSole ProprietorYesEnumeration Date8/17/2015Last Updated10/13/2021Contact InformationPractice LocationPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553Phone(503) 258-4200FaxUnlisted FaxMailing LocationMailing Address11035 NE Sandy Blvd, Portland, OR 97220-2553Phone(503) 258-4200FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer