Provider Demographics
NPI:1205342698
Name:PANTON, KENDRA (EDS)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:PANTON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:PANTON
Other - Last Name:BELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDS
Mailing Address - Street 1:6135 GULL HARBOR DR NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-9728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6135 GULL HARBOR DR NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-9728
Practice Address - Country:US
Practice Address - Phone:407-791-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1073244103K00000X
WA506889E103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst