Provider Demographics
NPI:1821305004
Name:ZUMBAHLEN, KENDRA LYNN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:LYNN
Last Name:ZUMBAHLEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11955 E 1800TH AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-7003
Mailing Address - Country:US
Mailing Address - Phone:217-821-1789
Mailing Address - Fax:
Practice Address - Street 1:11955 E 1800TH AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-7003
Practice Address - Country:US
Practice Address - Phone:217-821-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist