Provider Demographics
NPI:1821621152
Name:KINDELL, LOUISE OLIVIA (PSYD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:OLIVIA
Last Name:KINDELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JEFFERSON PKWY APT 225
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8816
Mailing Address - Country:US
Mailing Address - Phone:831-239-4309
Mailing Address - Fax:
Practice Address - Street 1:29345 SW TOWN CENTER LOOP E STE 110
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8486
Practice Address - Country:US
Practice Address - Phone:503-582-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21733103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist