Healthcare Provider Details

I. General information

NPI: 1134602592
Provider Name (Legal Business Name): KENDALL CHRISTINE ROSS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHIEF EVAN DR
FAIRBANKS AK
99709-4863
US

IV. Provider business mailing address

100 CHIEF EVAN DR
FAIRBANKS AK
99709-4863
US

V. Phone/Fax

Practice location:
  • Phone: 608-515-2770
  • Fax:
Mailing address:
  • Phone: 608-515-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number255962
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4808
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: