Provider Demographics
NPI:1396055158
Name:BAKONDI, KENNETH M
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:BAKONDI
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 1:2010 SW 3RD ST UNIT 21
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1789
Mailing Address - Country:US
Mailing Address - Phone:541-752-1705
Mailing Address - Fax:
Practice Address - Street 1:557 NW MONROE AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4721
Practice Address - Country:US
Practice Address - Phone:541-766-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)