Provider Demographics
NPI:1376967265
Name:KENDRICK, ERICA (M ED, ATC)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:M ED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HORTON FIELD HOUSE
Mailing Address - Street 2:CAMPUS BOX 7130
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61790-7130
Mailing Address - Country:US
Mailing Address - Phone:309-438-7246
Mailing Address - Fax:
Practice Address - Street 1:110 HORTON FIELD HOUSE
Practice Address - Street 2:CAMPUS BOX 7130
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61790-7130
Practice Address - Country:US
Practice Address - Phone:309-438-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL069.0035612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer