Individual
DR. KEN KORNELIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
15110 BOONES FERRY RD, STE 100E, LAKE OSWEGO, OR 97035-3452
(503) 538-6045
(503) 538-1598
Mailing address
15110 BOONES FERRY RD, STE 100E, LAKE OSWEGO, OR 97035-3452
(503) 636-8654
(503) 636-5630
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
872
OR
Other
Enumeration date
05/30/2007
Last updated
09/15/2017
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