Provider Demographics
NPI:1689241879
Name:BROTT, KENDRA ALISON (MAT, MS)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:ALISON
Last Name:BROTT
Suffix:
Gender:F
Credentials:MAT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36045 MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-8678
Mailing Address - Country:US
Mailing Address - Phone:541-603-4622
Mailing Address - Fax:
Practice Address - Street 1:725 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6008
Practice Address - Country:US
Practice Address - Phone:541-505-8621
Practice Address - Fax:541-505-8621
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6926101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional