Provider Demographics
NPI:1881404820
Name:ZOELLNER, KENDRA MARIE
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:MARIE
Last Name:ZOELLNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5314 S YALE AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6273
Mailing Address - Country:US
Mailing Address - Phone:918-203-8870
Mailing Address - Fax:
Practice Address - Street 1:5314 S YALE AVE STE 600
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6273
Practice Address - Country:US
Practice Address - Phone:918-203-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21342-P101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health