Provider Demographics
NPI:1073569869
Name:KENOFER, BRUCE PATRICK (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:PATRICK
Last Name:KENOFER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 NE BELKNAP CT STE 101G
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-8403
Mailing Address - Country:US
Mailing Address - Phone:503-846-1973
Mailing Address - Fax:
Practice Address - Street 1:4660 NE BELKNAP CT STE 101G
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8403
Practice Address - Country:US
Practice Address - Phone:503-846-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1370103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR108869Medicare UPIN