Individual
KENNETH POWELL-WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
714 NE ALBERTA ST, PORTLAND, OR 97211-3960
(503) 287-4932
Mailing address
PO BOX 11526, PORTLAND, OR 97211-0526
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
113668
OR
175T00000X
Peer Specialist
Primary
113668
OR
Other
Enumeration date
04/08/2025
Last updated
04/08/2025
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