Provider Demographics
NPI:1588334858
Name:CONLEY, KENDRA (BSW, ARS, CADAC II)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:BSW, ARS, CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 E HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1624
Mailing Address - Country:US
Mailing Address - Phone:765-307-8920
Mailing Address - Fax:
Practice Address - Street 1:3 BURLINGTON WOODS DR STE 301
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4514
Practice Address - Country:US
Practice Address - Phone:847-361-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-5164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)