Provider Demographics
NPI:1992776686
Name:KENDALL, JEFFREY (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:KENDALL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-648-7412
Mailing Address - Fax:214-645-2632
Practice Address - Street 1:909 FULTON STREET SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-3600
Practice Address - Fax:612-625-7627
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3189103T00000X
MNLP5994103TC0700X
DEB10000591103T00000X
TX35105103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DES76542Medicare UPIN
DE012602C60Medicare PIN