Provider Demographics
NPI:1508377516
Name:KENDRICK, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18300 S. HALSTED STREET STE B
Mailing Address - Street 2:MB #114
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425
Mailing Address - Country:US
Mailing Address - Phone:708-998-6935
Mailing Address - Fax:
Practice Address - Street 1:18300 S. HALSTED STE B
Practice Address - Street 2:MB #114
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-6042
Practice Address - Country:US
Practice Address - Phone:708-998-6935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490227241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical