KENNETH LAKE CORNOG

PORTLAND, OR
NPI1962289470
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: OR  R9487)
Enumeration Date2023-09-11
Last Update Date2025-10-06
Business Address
KENNETH LAKE CORNOG
3231 SE 50TH AVE
PORTLAND, OR 97206-2248
Phone number: 503-238-5203
Mailing Address
KENNETH LAKE CORNOG
716 SE 29TH AVE
PORTLAND, OR 97214-3028
Phone number: 518-409-6158
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