Provider Demographics
NPI:1407133754
Name:SMITH, KENDRA KAY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 E GUNN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1921
Mailing Address - Country:US
Mailing Address - Phone:248-742-9265
Mailing Address - Fax:
Practice Address - Street 1:124 W GATES ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BRUCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48065-4494
Practice Address - Country:US
Practice Address - Phone:586-752-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680100644081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical