Individual
KEVIN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW60535756
WA
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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