Provider Demographics
NPI:1033840202
Name:MCGRUDER, KENYA
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:MCGRUDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32300 SAN TIMOTEO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7961
Mailing Address - Country:US
Mailing Address - Phone:909-272-8189
Mailing Address - Fax:
Practice Address - Street 1:1200 CONCORD AVE STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4969
Practice Address - Country:US
Practice Address - Phone:510-268-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst