Provider Demographics
NPI:1962383604
Name:WALLACE, KENDRA (MHA, CD/PCD)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:
Last Name:WALLACE
Suffix:
Gender:F
Credentials:MHA, CD/PCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BARRIE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9937
Mailing Address - Country:US
Mailing Address - Phone:302-659-9094
Mailing Address - Fax:
Practice Address - Street 1:605 BARRIE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-9937
Practice Address - Country:US
Practice Address - Phone:302-659-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty