Provider Demographics
NPI:1720403629
Name:BROWN, KENDALL H (EDS)
Entity Type:Individual
Prefix:MR
First Name:KENDALL
Middle Name:H
Last Name:BROWN
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 POLE AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-4301
Mailing Address - Country:US
Mailing Address - Phone:440-227-1176
Mailing Address - Fax:
Practice Address - Street 1:2350 POLE AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-4301
Practice Address - Country:US
Practice Address - Phone:440-227-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP389103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool