Individual
KENDALL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2480 NE TWIN KNOLLS DR, BEND, OR 97701-6833
(541) 758-5900
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/11/2020
Last updated
11/11/2020
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