| Kendyl Watts Llc | |
|
2512 Se 25th Ave Ste 202 Portland OR 97202-2075 | |
| (503) 333-7649 | |
| Not Available |
| Full Name | Kendyl Watts Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2512 Se 25th Ave Ste 202, Portland, Oregon |
| Authorized Official Name and Position | Kendyl Watts (OWNER) |
| Authorized Official Contact | 5033337649 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kendyl Watts Llc 2512 Se 25th Ave Ste 202 Portland OR 97202-2075 Ph: (503) 333-7649 | Kendyl Watts Llc 2512 Se 25th Ave Ste 202 Portland OR 97202-2075 Ph: (503) 333-7649 |
| NPI Number | 1770044968 |
|---|---|
| Provider Enumeration Date | 03/29/2019 |
| Last Update Date | 07/22/2021 |
| Certification Date | 07/22/2021 |
| Medicare PECOS PAC ID | 8022351337 |
|---|---|
| Medicare Enrollment ID | O20190529002280 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770044968 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kendyl Watts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053885814 PECOS PAC ID: 9931442241 Enrollment ID: I20190529002355 |
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