Provider Demographics
NPI:1508124389
Name:KICKENDALL, ABBIE M (PHD)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:M
Last Name:KICKENDALL
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 1:4955 S DURANGO DR STE 207
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0156
Mailing Address - Country:US
Mailing Address - Phone:702-650-6508
Mailing Address - Fax:702-650-6508
Practice Address - Street 1:4955 S DURANGO DR STE 207
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0156
Practice Address - Country:US
Practice Address - Phone:702-650-6508
Practice Address - Fax:702-650-6508
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical