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NPI Code Detail

MEDICARE: SHANNON KENDALL

MEDICARE: SHANNON KENDALL
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1780519025
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON KENDALL
Provider Business Mailing Address
First Line : 2672 ORBIT DR
Second Line :
City : LAKE ORION
State : MI
Zip : 48360-2728
Country : US
Telephone Number : 248-561-0385
Fax Number :
Provider Business Practice Location Address
First Line : 955 CAMPUS DR N
Second Line :
City : WATERFORD
State : MI
Zip : 48328-2754
Country : US
Telephone Number : 248-475-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2026
Last Update Date : 06/17/2026

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Directions to “ SHANNON KENDALL ” Practice Location

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