Provider Demographics
NPI:1558940262
Name:MILLER, KENDRA JO (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 E. KELLOGG DR.
Mailing Address - Street 2:
Mailing Address - City:WITCHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218
Mailing Address - Country:US
Mailing Address - Phone:316-779-4871
Mailing Address - Fax:316-239-2746
Practice Address - Street 1:5500 E. KELLOGG DR.
Practice Address - Street 2:
Practice Address - City:WITCHITA
Practice Address - State:KS
Practice Address - Zip Code:67218
Practice Address - Country:US
Practice Address - Phone:316-779-4871
Practice Address - Fax:316-239-2746
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical