Provider Demographics
NPI:1588146534
Name:KENDALL, KYLEE ERIN (LAC)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:ERIN
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 GREENE TREE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1381
Mailing Address - Country:US
Mailing Address - Phone:410-318-6830
Mailing Address - Fax:
Practice Address - Street 1:1836 GREENE TREE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1381
Practice Address - Country:US
Practice Address - Phone:410-318-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD813012171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist