Healthcare Provider Details

I. General information

NPI: 1902367741
Provider Name (Legal Business Name): KENDRA DENISE WHITAKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 1ST ST BLDG 46
ALTUS AFB OK
73523-5004
US

IV. Provider business mailing address

100 CHARLES EWING BLVD STE 160
EWING NJ
08628-3456
US

V. Phone/Fax

Practice location:
  • Phone: 580-481-5419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6590
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: