Provider Demographics
NPI:1124739180
Name:UROM, CHIDOZIE KENNETH
Entity type:Individual
Prefix:
First Name:CHIDOZIE
Middle Name:KENNETH
Last Name:UROM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17602 NE CLACKAMAS TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6378
Mailing Address - Country:US
Mailing Address - Phone:971-219-6198
Mailing Address - Fax:
Practice Address - Street 1:7340 SW HUNZIKER RD STE 215
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2304
Practice Address - Country:US
Practice Address - Phone:503-778-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health