Provider Demographics
NPI:1013653559
Name:GRUBEN, KENDRA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:GRUBEN
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 1:800 ROGAN ST
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-3339
Mailing Address - Country:US
Mailing Address - Phone:325-646-8919
Mailing Address - Fax:
Practice Address - Street 1:800 ROGAN ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-3339
Practice Address - Country:US
Practice Address - Phone:325-646-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10892235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist