Healthcare Provider Details

I. General information

NPI: 1932349677
Provider Name (Legal Business Name): KENDRICK KWOCZALLA LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S MADISON ST
MUNCIE IN
47305-2465
US

IV. Provider business mailing address

PO BOX 1676
MUNCIE IN
47308-1676
US

V. Phone/Fax

Practice location:
  • Phone: 765-286-7000
  • Fax: 765-213-2760
Mailing address:
  • Phone: 765-286-7000
  • Fax: 765-213-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002202A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: