Provider Demographics
NPI:1144691700
Name:CURTIS, KENDALL D
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:D
Last Name:CURTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 NE 24TH ST APT 1212
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1346
Mailing Address - Country:US
Mailing Address - Phone:470-783-4745
Mailing Address - Fax:
Practice Address - Street 1:1260 NE 24TH ST APT 1212
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1346
Practice Address - Country:US
Practice Address - Phone:470-783-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004161235Z00000X
FLSA20144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist