Healthcare Provider Details

I. General information

NPI: 1457651416
Provider Name (Legal Business Name): KRISTA ASHLEY KENDHAMMER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 E LAKE MEAD PKWY 5
HENDERSON NV
89015-5530
US

IV. Provider business mailing address

2458 AVENIDA CORTES
HENDERSON NV
89074-6349
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-6723
  • Fax:
Mailing address:
  • Phone: 720-484-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: