Provider Demographics
NPI:1578707816
Name:MEYER, KENDALL COOKE (BCABA)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:COOKE
Last Name:MEYER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DUNNEMANN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3609
Mailing Address - Country:US
Mailing Address - Phone:303-619-1049
Mailing Address - Fax:843-727-0103
Practice Address - Street 1:14 DUNNEMANN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3609
Practice Address - Country:US
Practice Address - Phone:303-619-1049
Practice Address - Fax:843-727-0103
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst