Provider Demographics
NPI:1063080992
Name:WASIK, KENDRA LEIGH (AUD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:LEIGH
Last Name:WASIK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 WATERLYNN CIR NW APT 201
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0027
Mailing Address - Country:US
Mailing Address - Phone:860-951-8609
Mailing Address - Fax:
Practice Address - Street 1:1601 BRENNER AVE BLDG 42
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2515
Practice Address - Country:US
Practice Address - Phone:704-638-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2206101231H00000X
NC14979231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist