Provider Demographics
NPI:1376363085
Name:LEBLANC, KENDALL NICOLE (CCM)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:NICOLE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E BRIAR HOLLOW LN APT 1002
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-2979
Mailing Address - Country:US
Mailing Address - Phone:713-244-4032
Mailing Address - Fax:
Practice Address - Street 1:70 E BRIAR HOLLOW LN APT 1002
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-2979
Practice Address - Country:US
Practice Address - Phone:713-244-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4263368251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management