Provider Demographics
NPI:1255908778
Name:JORDAN, KENDALL BREE (PHD)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:BREE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13153 OLD HICKORY BLVD APT 804
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5009
Mailing Address - Country:US
Mailing Address - Phone:803-429-7706
Mailing Address - Fax:
Practice Address - Street 1:805 BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2105
Practice Address - Country:US
Practice Address - Phone:615-988-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3739103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool