Individual
KIM T PENGELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
998 LIBRARY CT, OREGON CITY, OR 97045-4041
(503) 655-8401
(503) 655-8429
Mailing address
2051 KAEN RD, SUITE 398, OREGON CITY, OR 97045-4088
(503) 742-5300
(503) 655-8350
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2604
OR
Other
Enumeration date
03/07/2006
Last updated
11/01/2012
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