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NPI Code Detail

MEDICARE: KENDRA ETHERIDGE

MEDICARE:   KENDRA  ETHERIDGE
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
11041C0700XClinical Social WorkerLC200001885DC

General Provider Information

NPI Number : 1902738008
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRA ETHERIDGE
Provider Business Mailing Address
First Line : 3700 N CAPITOL ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20011-8400
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 50 IRVING ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20422-0001
Country : US
Telephone Number : 301-728-1850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ KENDRA ETHERIDGE ” Practice Location

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