Provider Demographics
NPI:1114079936
Name:KIRKENDALL, LONNIE RENE (SLP)
Entity type:Individual
Prefix:MS
First Name:LONNIE
Middle Name:RENE
Last Name:KIRKENDALL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ENTERPRISE AVE NE STE C1
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-6811
Mailing Address - Country:US
Mailing Address - Phone:763-444-8700
Mailing Address - Fax:763-434-0192
Practice Address - Street 1:2 ENTERPRISE AVE NE STE C1
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-6811
Practice Address - Country:US
Practice Address - Phone:763-444-8700
Practice Address - Fax:763-434-0192
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist