Healthcare Provider Details

I. General information

NPI: 1154237840
Provider Name (Legal Business Name): KENDYLL GROVATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 PA ROUTE 100 STE. #202
OREFIELD PA
18069
US

IV. Provider business mailing address

2388 SILVANO DR
MACUNGIE PA
18062-8657
US

V. Phone/Fax

Practice location:
  • Phone: 484-340-6111
  • Fax:
Mailing address:
  • Phone: 484-707-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002709
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: