Healthcare Provider Details

I. General information

NPI: 1679791164
Provider Name (Legal Business Name): ANNE LAYBOURNE KENDALL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5247 WISCONSIN AVE NW SUITE 4
WASHINGTON DC
20015-2012
US

IV. Provider business mailing address

5247 WISCONSIN AVE NW SUITE 4
WASHINGTON DC
20015-2012
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-7699
  • Fax: 202-362-9633
Mailing address:
  • Phone: 202-686-7699
  • Fax: 202-362-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1468
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: