Provider Demographics
NPI:1093955221
Name:KENDRICK, JENNIFER K (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-0234
Mailing Address - Country:US
Mailing Address - Phone:662-219-3344
Mailing Address - Fax:855-610-2250
Practice Address - Street 1:110 UNION BELLE BLVD
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-8107
Practice Address - Country:US
Practice Address - Phone:662-869-3042
Practice Address - Fax:662-869-3405
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC57771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical