Individual
DR. KEVIN FREDERICK MALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1925 NW AMBERGLEN PKWY, SUITE 300, HILLSBORO, OR 97006-6945
(503) 906-5019
(503) 906-5193
Mailing address
PO BOX 1034, (PORTLAND VAMC - HILLS CBOC), PORTLAND, OR 97207-1034
(503) 906-5019
(503) 906-5193
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY13735
CA
103TC0700X
Clinical Psychologist
PSY13735
CA
103TH0004X
Health Psychologist
Primary
PSY 13735
CA
Other
Enumeration date
11/28/2005
Last updated
11/23/2009
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