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1548932130
KYLE GREGORY JOHANSEN
MCMINNVILLE, OR
NPI
1548932130
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
175T00000X Peer Specialist
Enumeration Date
2021-10-01
Last Update Date
2021-10-01
Business Address
KYLE GREGORY JOHANSEN
213 NE 10TH ST
MCMINNVILLE, OR 97128-4825
Phone number: 971-261-2259
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Mailing Address
KYLE GREGORY JOHANSEN
627 NE EVANS ST
MCMINNVILLE, OR 97128-3923
Phone number: 503-434-7527
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