Provider Demographics
NPI:1629486253
Name:KENDERDINE, SHAWN KATHLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:KATHLEEN
Last Name:KENDERDINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14604 9TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7039
Mailing Address - Country:US
Mailing Address - Phone:206-524-0554
Mailing Address - Fax:
Practice Address - Street 1:14604 9TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7039
Practice Address - Country:US
Practice Address - Phone:206-524-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical