Healthcare Provider Details

I. General information

NPI: 1184453383
Provider Name (Legal Business Name): KENDAL MARYCATHERINE DONNELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 RESEARCH PARK DR STE B-1A
ANN ARBOR MI
48108-2229
US

IV. Provider business mailing address

6006 GREATWATER DR
WINDERMERE FL
34786-5600
US

V. Phone/Fax

Practice location:
  • Phone: 734-794-2930
  • Fax:
Mailing address:
  • Phone: 407-921-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: