Provider Demographics
NPI:1215444724
Name:ALDERMAN, KENDALL
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:ALDERMAN
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 1:5764 PESCARA DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8405
Mailing Address - Country:US
Mailing Address - Phone:850-726-0890
Mailing Address - Fax:
Practice Address - Street 1:5215 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-5708
Practice Address - Country:US
Practice Address - Phone:850-270-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician