MEDICARE: MS. ANGELA JAYNE KENWARD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L10553	OR

General Provider Information

NPI Number	:	1467021378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA JAYNE KENWARD LCSW

Provider Business Mailing Address
First Line	:	PO BOX 96246
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97296
Country	:	US
Telephone Number	:	503-403-9781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 NE 41ST AVE APT 106
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3511
Country	:	US
Telephone Number	:	503-403-9781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	05/02/2022

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