MEDICARE: MRS. KENDYLL JO MCNEILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1215267042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENDYLL JO MCNEILL

Provider Business Mailing Address
First Line	:	3114 W OKLAHOMA AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-5033
Country	:	US
Telephone Number	:	580-747-7192
Fax Number	:

Provider Business Practice Location Address
First Line	:	3114 W OKLAHOMA AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-5033
Country	:	US
Telephone Number	:	580-747-7192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	12/29/2009

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