Provider Demographics
NPI:1699837922
Name:ALLISON, KENDRA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:ALLISON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E MOREHEAD ST STE 121
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2775
Mailing Address - Country:US
Mailing Address - Phone:704-794-8885
Mailing Address - Fax:
Practice Address - Street 1:801 E MOREHEAD ST STE 121
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2775
Practice Address - Country:US
Practice Address - Phone:704-794-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC146A6OtherBCBS
NC7412767Medicaid