Provider Demographics
NPI:1174315303
Name:HENDRICKSON, KENDALL
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:
Other - Last Name:LAVERTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 FLORENCE RD
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1010
Mailing Address - Country:US
Mailing Address - Phone:413-345-8194
Mailing Address - Fax:
Practice Address - Street 1:305 BICENTENNIAL HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1962
Practice Address - Country:US
Practice Address - Phone:413-733-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program