Provider Demographics
NPI:1811433782
Name:PAULSEN, KENDAL A (MS, TLMHC)
Entity type:Individual
Prefix:MRS
First Name:KENDAL
Middle Name:A
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:MS, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24480 RICHFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4273
Mailing Address - Country:US
Mailing Address - Phone:712-249-5422
Mailing Address - Fax:
Practice Address - Street 1:427 E KANESVILLE BLVD
Practice Address - Street 2:SUITE: 102
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9079
Practice Address - Country:US
Practice Address - Phone:712-249-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health