Provider Demographics
NPI:1477103794
Name:ANDERSON, KENDRA M (PHD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 FUNICULAR WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-3413
Mailing Address - Country:US
Mailing Address - Phone:870-872-7303
Mailing Address - Fax:
Practice Address - Street 1:1941 EAST RD STE 4358
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-6010
Practice Address - Country:US
Practice Address - Phone:713-486-0500
Practice Address - Fax:713-383-1435
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38080103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist