Provider Demographics
NPI:1326190463
Name:PATTON, KENDRA A (MSW)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:A
Last Name:PATTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:KENDRA
Other - Middle Name:A
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:710 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6324
Mailing Address - Country:US
Mailing Address - Phone:217-525-1064
Mailing Address - Fax:217-525-1651
Practice Address - Street 1:5220 S 6TH STREET RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5735
Practice Address - Country:US
Practice Address - Phone:217-757-7700
Practice Address - Fax:217-757-7799
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490123181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical