Healthcare Provider Details

I. General information

NPI: 1609484898
Provider Name (Legal Business Name): KENDRA SUNDIN MARCUSON BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S WESTWOOD DR
ISHPEMING MI
49849-2922
US

IV. Provider business mailing address

321 E OHIO ST
MARQUETTE MI
49855-3847
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-1023
  • Fax:
Mailing address:
  • Phone: 906-226-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001222
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: