Healthcare Provider Details

I. General information

NPI: 1386558740
Provider Name (Legal Business Name): JENNIFER LYNN KENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 N FM 1626
BUDA TX
78610-3860
US

IV. Provider business mailing address

1312 GOLDILOCKS LN
MANCHACA TX
78652-4532
US

V. Phone/Fax

Practice location:
  • Phone: 612-970-7821
  • Fax:
Mailing address:
  • Phone: 512-970-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number104045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: