Individual
IAN SEWARD KENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
155 S EMPIRE BLVD, COOS BAY, OR 97420-3374
(541) 756-3111
(541) 756-2111
Mailing address
155 S EMPIRE BLVD, COOS BAY, OR 97420-3374
(541) 756-3111
(541) 756-2111
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
23-CRM-2708
OR
Other
Enumeration date
12/19/2023
Last updated
12/19/2023
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