Provider Demographics
NPI:1346803442
Name:TUCKER, KENDRA E (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:E
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875-0085
Mailing Address - Country:US
Mailing Address - Phone:406-868-6011
Mailing Address - Fax:
Practice Address - Street 1:274 OLD CORVALLIS RD UNIT C
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3213
Practice Address - Country:US
Practice Address - Phone:405-351-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT239251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical