Healthcare Provider Details

I. General information

NPI: 1619853066
Provider Name (Legal Business Name): JONATHAN MICHAEL KENDALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 HORSESHOE DR
SANTA ROSA CA
95405-8139
US

IV. Provider business mailing address

2250 MESQUITE DR
SANTA ROSA CA
95405-8310
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-4433
  • Fax:
Mailing address:
  • Phone: 707-542-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: