Provider Demographics
NPI:1639503097
Name:KENDRICK, ELLA SUE
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:SUE
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 NE 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8903
Mailing Address - Country:US
Mailing Address - Phone:405-824-5248
Mailing Address - Fax:
Practice Address - Street 1:927 NE 27TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-8903
Practice Address - Country:US
Practice Address - Phone:405-824-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker