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General NPI Number Information
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NPI Number | 1992776686
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Entity Type | Individual
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Provider Name | JEFFREY KENDALL PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 909 FULTON STREET SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-625-3600
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Fax | 612-625-7627
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Provider Business Mailing Address
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Address Line | PO BOX 845347
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City | DALLAS
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State | TX
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Zip | 75284-5347
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Country | US
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Telephone | 214-648-7412
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Fax | 214-645-2632
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3189
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP5994
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | B10000591
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35105
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License Number State | TX
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