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General NPI Number Information
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NPI Number | 1942660196
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Entity Type | Individual
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Provider Name | ANDREW KENAGY
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Gender | Male
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 2266 MCGILCHRIST ST SE STE 220
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City | SALEM
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State | OR
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Zip | 97302-1019
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Country | US
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Telephone | 503-272-1445
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Fax | 503-832-6238
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Provider Business Mailing Address
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Address Line | 2601 25TH ST SE STE 420
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City | SALEM
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State | OR
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Zip | 97302-1285
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3073
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License Number State | OR
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