Provider Demographics
NPI:1619434743
Name:KIRKPATRICK, JOEL T
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:T
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 NE GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3312
Mailing Address - Country:US
Mailing Address - Phone:860-705-0778
Mailing Address - Fax:
Practice Address - Street 1:805 SE 151ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2916
Practice Address - Country:US
Practice Address - Phone:860-705-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist