MEDICARE: MR. CHARLES M KENNEDY NCAC II

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	101Y00000X	Counselor	97-04-91	OR

General Provider Information

NPI Number	:	1730320805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES M KENNEDY NCAC II

Provider Business Mailing Address
First Line	:	171 SW COURT ST
Second Line	:
City	:	DALLAS
State	:	OR
Zip	:	97338-3112
Country	:	US
Telephone Number	:	503-831-1423
Fax Number	:	503-831-1573

Provider Business Practice Location Address
First Line	:	171 SW COURT ST
Second Line	:
City	:	DALLAS
State	:	OR
Zip	:	97338-3112
Country	:	US
Telephone Number	:	503-831-1423
Fax Number	:	503-831-1573

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

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

Similar Medicare Providers

1265673339 — TOMOKO GERSCH PH.D.
Practice Location Address:

171 SW COURT ST
DALLAS, OR
97338-3112

Practice Phone: 503-831-1423
Practice Fax: 503-831-1573

1164111472 — OREGON RECOVERY BEHAVIORAL HEALTH
Practice Location Address:

147 SW COURT ST
DALLAS, OR
97338-3112

Practice Phone: 503-304-4358
Practice Fax:

1316725013 — AMBER STONE
Practice Location Address:

147 SW COURT ST
DALLAS, OR
97338-3112

Practice Phone: 503-304-4358
Practice Fax: 503-304-4361

1750495115 — DR. JUANITA DAY O.D.
Practice Location Address:

7111 MARVIN D LOVE FWY , STE 101
DALLAS, TX
75237-3112

Practice Phone: 817-453-6329
Practice Fax: 682-651-5559

1245421627 — DR. MICHAEL JOHN WING DDS
Practice Location Address:

3112 MAIN ST
DALLAS, TX
75226-1535

Practice Phone: 214-466-6610
Practice Fax:

1114273661 — DALLAS FIRE RESCUE
Practice Location Address:

5000 DOLPHIN RD , BLDG. A
DALLAS, TX
75223-3112

Practice Phone: 214-670-3220
Practice Fax:

Directions to “ MR. CHARLES M KENNEDY NCAC II” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.