Provider Demographics
NPI:1588244370
Name:GILLENTINE, KENDALL KING (MS, CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:KING
Last Name:GILLENTINE
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 ROAD 370
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-9717
Mailing Address - Country:US
Mailing Address - Phone:662-315-5243
Mailing Address - Fax:
Practice Address - Street 1:202 MARTINDALE LN
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1355
Practice Address - Country:US
Practice Address - Phone:662-993-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-4685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist