Individual
KORDELL NOLTAN KENNEMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
619 MADISON ST STE 108, OREGON CITY, OR 97045
(503) 387-3957
Mailing address
PO BOX 14900, DHS OFS IRS DBA OREGON STATE HOSPITAL, SALEM, OR 97309-5016
(503) 945-9840
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1633
OR
Other
Enumeration date
09/07/2006
Last updated
11/16/2020
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