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NPI Code Detail

MEDICARE: DR. KAY LYNN GENDRON PH.D.

MEDICARE: DR. KAY LYNN GENDRON PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPS-004675LPA
2103T00000XPsychologistLP3065MN

General Provider Information

NPI Number : 1306866942
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KAY LYNN GENDRON PH.D.
Provider Business Mailing Address
First Line : 955 MAIN ST
Second Line :
City : HONESDALE
State : PA
Zip : 18431-1903
Country : US
Telephone Number : 570-253-2171
Fax Number : 570-253-7788
Provider Business Practice Location Address
First Line : 955 MAIN ST
Second Line :
City : HONESDALE
State : PA
Zip : 18431-1903
Country : US
Telephone Number : 570-253-2171
Fax Number : 570-253-7788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/08/2007

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