Provider Demographics
NPI:1740658657
Name:GONDERMAN, KELLY (PSYD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:GONDERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2607
Mailing Address - Country:US
Mailing Address - Phone:562-698-8888
Mailing Address - Fax:562-698-8815
Practice Address - Street 1:11911 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2607
Practice Address - Country:US
Practice Address - Phone:562-698-8888
Practice Address - Fax:562-698-8815
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical