Individual
KENNYON PETERKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
2600 SE BELMONT ST, PORTLAND, OR 97214-2916
(503) 239-5738
Mailing address
2600 SE BELMONT ST, PORTLAND, OR 97214-2916
(503) 239-5738
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932639945
—
OR
Enumeration date
06/13/2017
Last updated
04/11/2018
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