Provider Demographics
NPI:1518678903
Name:KENDALL, RAEGAN LEIGH
Entity Type:Individual
Prefix:
First Name:RAEGAN
Middle Name:LEIGH
Last Name:KENDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 VALE ST APT 307
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1396
Mailing Address - Country:US
Mailing Address - Phone:231-675-7196
Mailing Address - Fax:
Practice Address - Street 1:945 BARLOW ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4250
Practice Address - Country:US
Practice Address - Phone:231-268-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician