Provider Demographics
NPI:1588386486
Name:KENDALL, TIFFANY DAWN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DAWN
Last Name:KENDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DAWN
Other - Last Name:STENSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 24TH AVE S STE 260
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4644
Mailing Address - Country:US
Mailing Address - Phone:206-382-5340
Mailing Address - Fax:
Practice Address - Street 1:1250 S PUGET DR APT H223
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4426
Practice Address - Country:US
Practice Address - Phone:407-233-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist