Provider Demographics
NPI:1437869609
Name:GRENADA, KENDRA A (MS, SAC-IT)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:A
Last Name:GRENADA
Suffix:
Gender:F
Credentials:MS, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W CLEVELAND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2956
Mailing Address - Country:US
Mailing Address - Phone:414-269-8356
Mailing Address - Fax:414-455-1915
Practice Address - Street 1:2727 W CLEVELAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2956
Practice Address - Country:US
Practice Address - Phone:414-269-8356
Practice Address - Fax:414-455-1915
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18022-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI18022-130OtherSAC-IT