Provider Demographics
NPI:1013591692
Name:KENDALL, JENNY LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2773
Mailing Address - Country:US
Mailing Address - Phone:208-669-3124
Mailing Address - Fax:
Practice Address - Street 1:906A N ALMON ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-8505
Practice Address - Country:US
Practice Address - Phone:208-669-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA611163611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical