Provider Demographics
NPI:1356625974
Name:LUTZOW, KENDRA N
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:N
Last Name:LUTZOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81709 DR CARREON BLVD
Mailing Address - Street 2:STE D-1
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5509
Mailing Address - Country:US
Mailing Address - Phone:760-347-2398
Mailing Address - Fax:
Practice Address - Street 1:81709 DR CARREON BLVD
Practice Address - Street 2:STE D-1
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5509
Practice Address - Country:US
Practice Address - Phone:760-347-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical