Individual
MR. CHARLES M KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NCAC II
Contact information
Practice address
171 SW COURT ST, DALLAS, OR 97338-3112
(503) 831-1423
(503) 831-1573
Mailing address
171 SW COURT ST, DALLAS, OR 97338-3112
(503) 831-1423
(503) 831-1573
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
97-04-91
OR
Other
Enumeration date
03/18/2009
Last updated
03/18/2009
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