Provider Demographics
NPI:1285024620
Name:OOSTERHOUSE, KENDRA LYNNE (TLLP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYNNE
Last Name:OOSTERHOUSE
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 W. WIGWAM WAY
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349
Mailing Address - Country:US
Mailing Address - Phone:616-644-1083
Mailing Address - Fax:
Practice Address - Street 1:12048 JAMES ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9661
Practice Address - Country:US
Practice Address - Phone:616-644-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016212103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling