Provider Demographics
NPI:1649090622
Name:JONSSON, KENDALL (LPC-A)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:JONSSON
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:376 SW BLUFF DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1399
Mailing Address - Country:US
Mailing Address - Phone:541-887-0320
Mailing Address - Fax:
Practice Address - Street 1:376 SW BLUFF DR STE 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1399
Practice Address - Country:US
Practice Address - Phone:541-887-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR10045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health