Provider Demographics
NPI:1366750697
Name:TYLER, KENDRA MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:MARIE
Last Name:TYLER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 S. ELIZABETH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2431
Mailing Address - Country:US
Mailing Address - Phone:765-454-9748
Mailing Address - Fax:765-450-6664
Practice Address - Street 1:625 N. UNION STREET
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-2907
Practice Address - Country:US
Practice Address - Phone:765-454-9748
Practice Address - Fax:765-450-6664
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005337A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist