Individual
MR. CODY LEE MCKINNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4455 NE HIGHWAY 20, CORVALLIS, OR 97330-9695
(541) 758-5975
Mailing address
1722 TRUDELL CT SE, ALBANY, OR 97322-6983
(541) 908-5256
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
9432205
OR
Other
Enumeration date
05/25/2007
Last updated
07/08/2007
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