Provider Demographics
NPI:1063804474
Name:BRACAMONTES, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BRACAMONTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 S PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-3468
Mailing Address - Country:US
Mailing Address - Phone:480-282-7728
Mailing Address - Fax:
Practice Address - Street 1:2119 S PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3468
Practice Address - Country:US
Practice Address - Phone:480-282-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-22
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA92462355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant