Provider Demographics
NPI:1730935941
Name:BEARD, KENDRA ALY'CE
Entity type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:ALY'CE
Last Name:BEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 THORNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6192
Mailing Address - Country:US
Mailing Address - Phone:937-727-3167
Mailing Address - Fax:
Practice Address - Street 1:4439 THORNBERRY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-6196
Practice Address - Country:US
Practice Address - Phone:614-741-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services