Provider Demographics
NPI:1912221573
Name:LEINGANG, KENDRA MARIE (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:MARIE
Last Name:LEINGANG
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 JONES ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3987
Mailing Address - Country:US
Mailing Address - Phone:949-233-0278
Mailing Address - Fax:415-749-2791
Practice Address - Street 1:20 JONES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3987
Practice Address - Country:US
Practice Address - Phone:949-233-0278
Practice Address - Fax:415-749-2791
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT INTERN IMF 68530106H00000X
CA82202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720385032Medicaid