Individual
MR. KENDALL M JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
9155 SW BARNES RD STE 333, PORTLAND, OR 97225-6630
(503) 216-5102
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
L5441
OR
1041C0700X
Clinical Social Worker
075642
NY
1041C0700X
Clinical Social Worker
Primary
L5441
—
Other
Enumeration date
01/29/2007
Last updated
03/24/2020
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