Provider Demographics
NPI:1558878611
Name:LILLARD, KENDALL RENEE
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:RENEE
Last Name:LILLARD
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 1:10216 SNOWFLAKE LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1211
Mailing Address - Country:US
Mailing Address - Phone:513-918-8062
Mailing Address - Fax:513-818-4680
Practice Address - Street 1:2203 FULTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206
Practice Address - Country:US
Practice Address - Phone:513-961-4663
Practice Address - Fax:513-961-4681
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.164850101YA0400X
OH00483175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist