Healthcare Provider Details

I. General information

NPI: 1972326460
Provider Name (Legal Business Name): KENDRICK HOGUE MA, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KENDRICK CRONIN

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 WYCLIFF ST STE 102
SAINT PAUL MN
55114-1257
US

IV. Provider business mailing address

2380 WYCLIFF ST STE 102
SAINT PAUL MN
55114-1257
US

V. Phone/Fax

Practice location:
  • Phone: 651-647-1083
  • Fax: 651-642-1230
Mailing address:
  • Phone: 651-647-1083
  • Fax: 651-642-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4675
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: