Provider Demographics
NPI:1467021378
Name:KENWARD, ANGELA JAYNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JAYNE
Last Name:KENWARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96246
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97296
Mailing Address - Country:US
Mailing Address - Phone:503-403-9781
Mailing Address - Fax:
Practice Address - Street 1:1521 NE 41ST AVE APT 106
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3511
Practice Address - Country:US
Practice Address - Phone:503-403-9781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL105531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical