Provider Demographics
NPI:1437154903
Name:CONDREY, KENDRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:CONDREY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 RED ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4158
Mailing Address - Country:US
Mailing Address - Phone:828-724-4727
Mailing Address - Fax:828-724-4727
Practice Address - Street 1:38 RED ROBIN WAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4158
Practice Address - Country:US
Practice Address - Phone:828-724-4727
Practice Address - Fax:828-724-4727
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7485659Medicaid
NC85659OtherNC BCBS