Individual
MARY JANE KENNEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
990 NW CIRCLE BLVD STE 201, CORVALLIS, OR 97330-1410
(541) 768-6412
Mailing address
990 NW CIRCLE BLVD STE 201, CORVALLIS, OR 97330-1410
(541) 768-6412
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5919
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5919
OREGON STATE LICENSE
OR
Enumeration date
06/08/2009
Last updated
06/08/2009
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