Provider Demographics
NPI:1780929554
Name:MCADEN, KENDIS RESPESS (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KENDIS
Middle Name:RESPESS
Last Name:MCADEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 IDYLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5174
Mailing Address - Country:US
Mailing Address - Phone:703-975-1530
Mailing Address - Fax:
Practice Address - Street 1:5015 LEE HWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-2532
Practice Address - Country:US
Practice Address - Phone:703-623-1806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA12014126OtherASHA
VA2202003345OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS