Most Relevant Information
Provider Data
| NPI Number: | 1003049909 |
| Provider Name: | KEVIN RICHARDSON |
| Entity Type: | Individual |
| Taxonomy Code: | 372600000X |
| Specialty: | Adult Companion |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/26/2009 |
| Last Updated: | 08/26/2009 |
Provider Practice Location
5029 NE KILLINGSWORTH ST
PORTLAND
OR
97218
Practice Location Phone/Fax
| Phone: | 5034028117 |
| Fax: |
Provider Mailing Location
PO BOX 8459
PORTLAND
OR
972078459
Provider Mailing Phone/Fax
| Phone: | 5032380769 |
| Fax: |