Provider Demographics
NPI:1811658800
Name:KENDALL, ANNE (BCBA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W 900 S
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:IN
Mailing Address - Zip Code:47234-9773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 W JACKSON ST STE B
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-4200
Practice Address - Country:US
Practice Address - Phone:317-512-3063
Practice Address - Fax:317-663-2947
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst