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1962289470
KENNETH LAKE CORNOG
PORTLAND, OR
NPI
1962289470
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: OR R9487)
Enumeration Date
2023-09-11
Last Update Date
2025-10-06
Business Address
KENNETH LAKE CORNOG
3231 SE 50TH AVE
PORTLAND, OR 97206-2248
Phone number: 503-238-5203
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Mailing Address
KENNETH LAKE CORNOG
716 SE 29TH AVE
PORTLAND, OR 97214-3028
Phone number: 518-409-6158
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