Provider Demographics
NPI:1164966560
Name:WOODWORTH, KENDRA ANN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:ANN
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 LILAC DR N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4535
Mailing Address - Country:US
Mailing Address - Phone:763-545-7708
Mailing Address - Fax:763-545-3479
Practice Address - Street 1:1405 LILAC DR N
Practice Address - Street 2:SUITE 200
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4535
Practice Address - Country:US
Practice Address - Phone:763-545-7708
Practice Address - Fax:763-545-3479
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6072103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical