Provider Demographics
NPI:1528835006
Name:WELCH, KENDALL (ND)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 SW BROADWAY DR APT 41
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-6717
Mailing Address - Country:US
Mailing Address - Phone:831-212-3778
Mailing Address - Fax:
Practice Address - Street 1:1306 NW HOYT ST STE 302
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2786
Practice Address - Country:US
Practice Address - Phone:503-208-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5030175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath