1619494630 NPI number — MRS. KENDRA NICOLE HEMMINGER LPC

Table of content: MRS. KENDRA NICOLE HEMMINGER LPC (NPI 1619494630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619494630 NPI number — MRS. KENDRA NICOLE HEMMINGER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEMMINGER
Provider First Name:
KENDRA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GORMAN
Provider Other First Name:
KENDRA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
KENDRA GORMAN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619494630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 OHIO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45373-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-474-3380
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
651 S LIMESTONE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45505-1965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-324-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  C.1700633 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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