Provider Demographics
NPI:1235848151
Name:MOHLENBRINK, KENDALL JEAN (LMSW)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:JEAN
Last Name:MOHLENBRINK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 S TULIP PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-7020
Mailing Address - Country:US
Mailing Address - Phone:208-490-7442
Mailing Address - Fax:
Practice Address - Street 1:6051 S TULIP PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-7020
Practice Address - Country:US
Practice Address - Phone:208-490-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist