Healthcare Provider Details

I. General information

NPI: 1326190463
Provider Name (Legal Business Name): KENDRA A PATTON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA A EDWARDS MSW

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 S 6TH STREET RD SUITE 2400
SPRINGFIELD IL
62703-5735
US

IV. Provider business mailing address

710 N 8TH ST
SPRINGFIELD IL
62702-6324
US

V. Phone/Fax

Practice location:
  • Phone: 217-757-7700
  • Fax: 217-757-7799
Mailing address:
  • Phone: 217-525-1064
  • Fax: 217-525-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012318
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: