Individual
KENNETH ALAN ENSROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 DIVISION ST, CHILD CLINIC, OREGON CITY, OR 97045-1527
(503) 722-3700
(503) 722-3750
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 722-3700
(503) 722-3750
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD22953
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287772
—
OR
05
—
500656755
—
OR
Enumeration date
07/31/2006
Last updated
03/09/2021
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