Provider Demographics
NPI:1578297818
Name:GUNDERMAN, KENDALL LEIGH
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:LEIGH
Last Name:GUNDERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:LEIGH
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35909 140TH ST
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MN
Mailing Address - Zip Code:56119-1945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:567 N 5TH ST RM 230
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-1903
Practice Address - Country:US
Practice Address - Phone:812-237-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program