Provider Demographics
NPI:1437563327
Name:KLASSEN, KENDRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23792 ROCKFIELD BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2819
Mailing Address - Country:US
Mailing Address - Phone:949-303-8933
Mailing Address - Fax:
Practice Address - Street 1:23792 ROCKFIELD BLVD STE 290
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2819
Practice Address - Country:US
Practice Address - Phone:949-303-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical