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General NPI Number Information
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NPI Number | 1871903922
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Entity Type | Individual
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Provider Name | KENDRA POTSUBAY M.S./CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 393 ADAMS ST
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City | ROCHESTER
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State | PA
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Zip | 15074-2128
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Country | US
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Telephone | 724-774-2677
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 247 145 NAIL ROAD
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City | EAU CLAIRE
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State | PA
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Zip | 16030-0247
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Country | US
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Telephone | 724-991-8070
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL011251
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License Number State | PA
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