Provider Demographics
NPI:1366058885
Name:SYSAK, KENDRA (MS PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:SYSAK
Suffix:
Gender:F
Credentials:MS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4728
Mailing Address - Country:US
Mailing Address - Phone:988-401-8990
Mailing Address - Fax:989-401-8992
Practice Address - Street 1:1232 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4728
Practice Address - Country:US
Practice Address - Phone:989-714-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling