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NPI Code Detail

MEDICARE: AUDREY CAMILLE KENDALL LLMSW

MEDICARE:   AUDREY CAMILLE KENDALL  LLMSW
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
1104100000XSocial Worker6801095696MI
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1760818728
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY CAMILLE KENDALL LLMSW
Provider Business Mailing Address
First Line : 320 COMMERCE AVE SW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-4101
Country : US
Telephone Number : 616-258-7599
Fax Number : 616-222-4571
Provider Business Practice Location Address
First Line : 320 COMMERCE AVE SW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-4101
Country : US
Telephone Number : 616-258-7599
Fax Number : 616-222-4571
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2013
Last Update Date : 04/02/2015

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Directions to “ AUDREY CAMILLE KENDALL LLMSW” Practice Location

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