Healthcare Provider Details

I. General information

NPI: 1093955221
Provider Name (Legal Business Name): JENNIFER K KENDRICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER K WILDER LCSW

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 10/15/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 UNION BELLE BLVD
SALTILLO MS
38866-8107
US

IV. Provider business mailing address

PO BOX 234
BOONEVILLE MS
38829-0234
US

V. Phone/Fax

Practice location:
  • Phone: 662-869-3042
  • Fax: 662-869-3405
Mailing address:
  • Phone: 662-219-3344
  • Fax: 855-610-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC5777
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: