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General NPI Number Information
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NPI Number | 1740498625
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Entity Type | Individual
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Provider Name | KENDRA NICKERSON PHD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 236 S MENTOR AVE APT 7
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City | PASADENA
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State | CA
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Zip | 91106-3218
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Country | US
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Telephone | 626-354-4623
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Fax |
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Provider Business Mailing Address
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Address Line | 236 S MENTOR AVE APT 7
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City | PASADENA
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State | CA
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Zip | 91106-3218
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Country | US
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Telephone | 626-354-4623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY21039
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License Number State | CA
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