Healthcare Provider Details

I. General information

NPI: 1134033970
Provider Name (Legal Business Name): KENNEDY ZETA NOONAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 SW 190TH AVE
BEAVERTON OR
97078-4564
US

IV. Provider business mailing address

6530 SW 190TH AVE
BEAVERTON OR
97078-4564
US

V. Phone/Fax

Practice location:
  • Phone: 503-270-7876
  • Fax:
Mailing address:
  • Phone: 503-270-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: