Healthcare Provider Details

I. General information

NPI: 1396465928
Provider Name (Legal Business Name): KENDRA CAROLINE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 FRONT ST NE
SALEM OR
97301-0775
US

IV. Provider business mailing address

PO BOX 12473
SALEM OR
97309-0473
US

V. Phone/Fax

Practice location:
  • Phone: 503-420-3194
  • Fax:
Mailing address:
  • Phone: 503-343-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL17616
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: