Provider Demographics
NPI:1730419292
Name:KENDIG, JEFFREY (MA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:KENDIG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-0182
Mailing Address - Country:US
Mailing Address - Phone:303-646-0556
Mailing Address - Fax:
Practice Address - Street 1:34061 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-7842
Practice Address - Country:US
Practice Address - Phone:303-646-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO344101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor