MEDICARE: MR. SHERRILL KENDRICK PH.D

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	103TC0700X	Clinical Psychologist	21246	TX

General Provider Information

NPI Number	:	1841328192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHERRILL KENDRICK PH.D

Provider Business Mailing Address
First Line	:	3213 W ALBERTA RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-9635
Country	:	US
Telephone Number	:	956-618-0046
Fax Number	:	956-618-0048

Provider Business Practice Location Address
First Line	:	3213 W ALBERTA RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-9635
Country	:	US
Telephone Number	:	956-618-0046
Fax Number	:	956-618-0048

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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