Provider Demographics
NPI:1396125738
Name:GRASS, KENDRA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:GRASS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:EMMETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:710 GRAND AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-5852
Mailing Address - Country:US
Mailing Address - Phone:406-672-3707
Mailing Address - Fax:406-259-3951
Practice Address - Street 1:2016 GRAND AVE STE D
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2675
Practice Address - Country:US
Practice Address - Phone:406-672-3707
Practice Address - Fax:406-259-3951
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-6579235Z00000X
MTSLP-SP-TMP-4923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist