Provider Demographics
NPI:1740020619
Name:FRAZIER, KENDALL NICOLE (CADCII)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:NICOLE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 E ROUTE 66 STE 106
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3783
Mailing Address - Country:US
Mailing Address - Phone:626-620-2627
Mailing Address - Fax:
Practice Address - Street 1:1340 E ROUTE 66 STE 106
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3783
Practice Address - Country:US
Practice Address - Phone:626-620-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA053440323101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)