Healthcare Provider Details

I. General information

NPI: 1518877026
Provider Name (Legal Business Name): KENDRA BOSTICK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 HENNEPIN AVE STE 210B
MINNEAPOLIS MN
55408-3413
US

IV. Provider business mailing address

2803 PLEASANT AVE
MINNEAPOLIS MN
55408-2250
US

V. Phone/Fax

Practice location:
  • Phone: 612-314-6943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32350
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: