Healthcare Provider Details

I. General information

NPI: 1689235285
Provider Name (Legal Business Name): KENDRA M SMITH-WEHR MED, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 SUMERLIN CT
BUCKNER KY
40010-8845
US

IV. Provider business mailing address

5001 SUMERLIN CT
BUCKNER KY
40010-8845
US

V. Phone/Fax

Practice location:
  • Phone: 502-500-0646
  • Fax:
Mailing address:
  • Phone: 502-500-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number245074
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: