Healthcare Provider Details

I. General information

NPI: 1497689293
Provider Name (Legal Business Name): KENDALL SMITH MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 CENTENNIAL LOOP
EUGENE OR
97401-7909
US

IV. Provider business mailing address

4872 THUNDERBIRD ST
EUGENE OR
97404-3319
US

V. Phone/Fax

Practice location:
  • Phone: 541-255-2681
  • Fax:
Mailing address:
  • Phone: 541-510-5826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18546
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: