Provider Demographics
NPI:1124292644
Name:KENDRICK, NANCY BETH (MA CCC-A)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:BETH
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CRESCENT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112-1016
Mailing Address - Country:US
Mailing Address - Phone:215-503-3300
Mailing Address - Fax:215-503-3321
Practice Address - Street 1:3 CRESCENT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1016
Practice Address - Country:US
Practice Address - Phone:215-503-3300
Practice Address - Fax:215-503-3321
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000402L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA186660Medicare PIN