Provider Demographics
NPI:1376019463
Name:EAGLY, KENDRA LOUWAN (LLBSW)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:LOUWAN
Last Name:EAGLY
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5297 W SHEARER RD
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48618-9340
Mailing Address - Country:US
Mailing Address - Phone:989-941-2214
Mailing Address - Fax:
Practice Address - Street 1:301 S CRAPO ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-772-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802090130104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker