Healthcare Provider Details

I. General information

NPI: 1992412985
Provider Name (Legal Business Name): KENDALL RHIANN HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 N STATE ROUTE 66
DEFIANCE OH
43512-6730
US

IV. Provider business mailing address

6825 N STATE ROUTE 66
DEFIANCE OH
43512-6730
US

V. Phone/Fax

Practice location:
  • Phone: 419-576-5015
  • Fax:
Mailing address:
  • Phone: 419-576-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-26-2826767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: