Healthcare Provider Details

I. General information

NPI: 1417529843
Provider Name (Legal Business Name): KENDRA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 NW CROSSING DR STE 233
BEND OR
97703-7050
US

IV. Provider business mailing address

2755 NW CROSSING DR STE 233
BEND OR
97703-7050
US

V. Phone/Fax

Practice location:
  • Phone: 971-291-6164
  • Fax:
Mailing address:
  • Phone: 971-291-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC9193
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: