Provider Demographics
NPI:1407020886
Name:KIRKENDALL, JONATHAN DALE (MA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DALE
Last Name:KIRKENDALL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 QUINCY ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2615
Mailing Address - Country:US
Mailing Address - Phone:202-526-4445
Mailing Address - Fax:202-526-7401
Practice Address - Street 1:1325 QUINCY ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2615
Practice Address - Country:US
Practice Address - Phone:202-526-4445
Practice Address - Fax:202-526-7401
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13592101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional