Provider Demographics
NPI:1841999885
Name:WALKER, KENDALL LYNN
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:LYNN
Other - Last Name:LEON WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1560 BROOKHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5411
Mailing Address - Country:US
Mailing Address - Phone:949-645-4723
Mailing Address - Fax:
Practice Address - Street 1:1560 BROOKHOLLOW DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5411
Practice Address - Country:US
Practice Address - Phone:949-645-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138131106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist