MEDICARE: KENDALL BRUNDRETT BCBA, LBA

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
1	103K00000X	Behavior Analyst	BEH-000861	AZ

General Provider Information

NPI Number	:	1447999248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL BRUNDRETT BCBA, LBA

Provider Business Mailing Address
First Line	:	4635 N 22ND ST UNIT 212
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4634
Country	:	US
Telephone Number	:	858-413-5820
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 E THUNDERBIRD RD STE 1
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-3539
Country	:	US
Telephone Number	:	480-848-0707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/15/2026

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