Individual
BRAD LEE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
2402 BROADWAY ST, VANCOUVER, WA 98663-3229
(360) 241-6630
Mailing address
13502 SE HAROLD ST, PORTLAND, OR 97236-4149
(503) 933-8717
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA60188011
WA
Other
Enumeration date
11/15/2011
Last updated
11/15/2011
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