Provider Demographics
NPI:1346525300
Name:KENDRA J. SUMMERS, PHD
Entity Type:Organization
Organization Name:KENDRA J. SUMMERS, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-697-4829
Mailing Address - Street 1:9 SW MONROE PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8867
Mailing Address - Country:US
Mailing Address - Phone:503-697-4829
Mailing Address - Fax:503-635-8411
Practice Address - Street 1:9 SW MONROE PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8867
Practice Address - Country:US
Practice Address - Phone:503-697-4829
Practice Address - Fax:503-635-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty