Provider Demographics
NPI:1750005484
Name:KENYON, ASHLEIGH (MACOM, DAOM)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:KENYON
Suffix:
Gender:F
Credentials:MACOM, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 SW RIVER SQ
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-8017
Mailing Address - Country:US
Mailing Address - Phone:607-624-0392
Mailing Address - Fax:
Practice Address - Street 1:2262 N ALBINA AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1792
Practice Address - Country:US
Practice Address - Phone:503-493-9389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC194944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist