Provider Demographics
NPI:1881135515
Name:MCANALLY, KENDALL (LAC)
Entity type:Individual
Prefix:MS
First Name:KENDALL
Middle Name:
Last Name:MCANALLY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 NE 136TH AVE APT 155
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5970
Mailing Address - Country:US
Mailing Address - Phone:512-906-8685
Mailing Address - Fax:
Practice Address - Street 1:100 E 19TH ST STE 500
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3385
Practice Address - Country:US
Practice Address - Phone:360-313-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61529334171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty