Healthcare Provider Details

I. General information

NPI: 1316518319
Provider Name (Legal Business Name): KENDALL HOMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W BROADWAY ST
INGALLS IN
46048-9500
US

IV. Provider business mailing address

2025 E BROADWAY ST
FORTVILLE IN
46040-9252
US

V. Phone/Fax

Practice location:
  • Phone: 765-621-6670
  • Fax:
Mailing address:
  • Phone: 765-621-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33010822A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011591A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: