Provider Demographics
NPI:1750636361
Name:COTTRELL, KENDRA PAIGE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:PAIGE
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-1236
Mailing Address - Country:US
Mailing Address - Phone:479-650-3163
Mailing Address - Fax:
Practice Address - Street 1:1036 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-6807
Practice Address - Country:US
Practice Address - Phone:479-650-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP 3135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist