Individual
KATLYNN RENEA PENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
29197 SW ORLEANS AVE, WILSONVILLE, OR 97070-7388
(503) 427-0182
(503) 427-0228
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
(503) 552-6208
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/23/2012
Last updated
07/23/2012
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