Provider Demographics
NPI:1851522874
Name:KIRKENDALL, ELY JANE
Entity Type:Individual
Prefix:
First Name:ELY
Middle Name:JANE
Last Name:KIRKENDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELINOR
Other - Middle Name:J
Other - Last Name:KIRKENDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3683 CHINO AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4719
Mailing Address - Country:US
Mailing Address - Phone:909-628-1272
Mailing Address - Fax:
Practice Address - Street 1:3683 CHINO AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4719
Practice Address - Country:US
Practice Address - Phone:909-628-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health