Provider Demographics
NPI:1689235285
Name:SMITH-WEHR, KENDRA M (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:M
Last Name:SMITH-WEHR
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 SUMERLIN CT
Mailing Address - Street 2:
Mailing Address - City:BUCKNER
Mailing Address - State:KY
Mailing Address - Zip Code:40010-8845
Mailing Address - Country:US
Mailing Address - Phone:502-500-0646
Mailing Address - Fax:
Practice Address - Street 1:5001 SUMERLIN CT
Practice Address - Street 2:
Practice Address - City:BUCKNER
Practice Address - State:KY
Practice Address - Zip Code:40010-8845
Practice Address - Country:US
Practice Address - Phone:502-500-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245074103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-29166OtherBACB