Basic Information
| Provider Information | |||||||||
| NPI: | 1427600873 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENDRA | ||||||||
| FirstName: | BROOK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 HICKORY TRACE DR | ||||||||
| Address2: | |||||||||
| City: | GIRARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444201009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309799009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 NORTHWEST AVE # A-120 | ||||||||
| Address2: | |||||||||
| City: | TALLMADGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442781808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306334187 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2019 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.