Individual
KENJAMIN MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1720 NW LOVEJOY ST STE 339, PORTLAND, OR 97209-2346
(971) 420-6656
Mailing address
1406 NE HOLMAN ST, PORTLAND, OR 97211-4144
(971) 420-6656
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
BAP-E-10259355
OR
Other
Enumeration date
10/08/2025
Last updated
10/08/2025
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