Provider Demographics
NPI:1124319579
Name:KORDENBROCK, TAWNYA (LPCA)
Entity type:Individual
Prefix:
First Name:TAWNYA
Middle Name:
Last Name:KORDENBROCK
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15742
Mailing Address - Street 2:3800 CHURCH STREET
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-0742
Mailing Address - Country:US
Mailing Address - Phone:859-468-7534
Mailing Address - Fax:
Practice Address - Street 1:3800 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-0742
Practice Address - Country:US
Practice Address - Phone:859-468-7534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1084101YP2500X
OHC 0700029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional