Provider Demographics
NPI:1164759429
Name:KENDZIOR, RACHEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:KENDZIOR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 59TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-4382
Mailing Address - Country:US
Mailing Address - Phone:941-545-1207
Mailing Address - Fax:941-721-6303
Practice Address - Street 1:3739 59TH AVENUE CIR E
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-4382
Practice Address - Country:US
Practice Address - Phone:941-545-1207
Practice Address - Fax:941-721-6303
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist