Healthcare Provider Details

I. General information

NPI: 1699022301
Provider Name (Legal Business Name): DANIEL RICHARD KENAGY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 ARLETA AVE NE
KEIZER OR
97303-4758
US

IV. Provider business mailing address

4062 ARLETA AVE NE
KEIZER OR
97303-4758
US

V. Phone/Fax

Practice location:
  • Phone: 503-390-2271
  • Fax:
Mailing address:
  • Phone: 503-390-2271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14017
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: