Provider Demographics
NPI:1942720966
Name:KUYKENDALL, JARROD
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 MORNING STAR PL
Mailing Address - Street 2:
Mailing Address - City:FORESTHILL
Mailing Address - State:CA
Mailing Address - Zip Code:95631-9774
Mailing Address - Country:US
Mailing Address - Phone:530-401-3162
Mailing Address - Fax:
Practice Address - Street 1:4554 MORNINGSTAR PL.
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631-9563
Practice Address - Country:US
Practice Address - Phone:530-401-3162
Practice Address - Fax:530-401-3162
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty