Provider Demographics
NPI:1619488491
Name:DAUGHERTY, KENDRA (LSW)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:8135 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43071-9670
Mailing Address - Country:US
Mailing Address - Phone:740-345-5437
Mailing Address - Fax:
Practice Address - Street 1:8135 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:ST LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:43071-9670
Practice Address - Country:US
Practice Address - Phone:740-345-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700313104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker