Provider Demographics
NPI:1902901697
Name:SUMMERS, KENDRA JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:JOAN
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SW MONROE PARKWAY
Mailing Address - Street 2:STE 280
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8867
Mailing Address - Country:US
Mailing Address - Phone:503-697-4829
Mailing Address - Fax:503-635-8411
Practice Address - Street 1:9 SW MONROE PARKWAY
Practice Address - Street 2:STE 280
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8867
Practice Address - Country:US
Practice Address - Phone:503-697-4829
Practice Address - Fax:503-635-8411
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical