Provider Demographics
NPI:1215281357
Name:KIRK, KENDRA MARIE (MS)
Entity type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:MARIE
Last Name:KIRK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55475 GROSS DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-2593
Mailing Address - Country:US
Mailing Address - Phone:805-794-6548
Mailing Address - Fax:
Practice Address - Street 1:55475 GROSS DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97707-2593
Practice Address - Country:US
Practice Address - Phone:805-794-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist