Provider Demographics
NPI:1790423648
Name:BOZARD, KENDRA ALLISON JOWERS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:ALLISON JOWERS
Last Name:BOZARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 HUDSON DR NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4222
Mailing Address - Country:US
Mailing Address - Phone:850-499-2191
Mailing Address - Fax:
Practice Address - Street 1:214 HUDSON DR NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4222
Practice Address - Country:US
Practice Address - Phone:850-499-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1978701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19870OtherLCSW LICENSE NUMBER