Provider Demographics
NPI:1235643586
Name:NORMAN, KENDALL LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:LEE
Last Name:NORMAN
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 1:1004 HURON TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-9415
Mailing Address - Country:US
Mailing Address - Phone:850-524-8317
Mailing Address - Fax:855-795-1904
Practice Address - Street 1:2940 E PARK AVE # 2F
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3446
Practice Address - Country:US
Practice Address - Phone:850-895-9394
Practice Address - Fax:855-795-1904
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-23
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100127500Medicaid