Healthcare Provider Details

I. General information

NPI: 1598602831
Provider Name (Legal Business Name): KENDALL ELIESE MYERS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 NC-54 STE 240, 360
DURHAM NC
27713
US

IV. Provider business mailing address

1920 NC-54 STE 240, 360
DURHAM NC
27113
US

V. Phone/Fax

Practice location:
  • Phone: 919-378-1340
  • Fax:
Mailing address:
  • Phone: 919-378-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14492257
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: