Provider Demographics
NPI:1386161073
Name:KENDRICK, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KENDRICK
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 1:402 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61501-8670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:402 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:IL
Practice Address - Zip Code:61501-8670
Practice Address - Country:US
Practice Address - Phone:309-329-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool