1700487071 NPI number — AMANDA PAIGE KENDIG LCSW

Table of content: AMANDA PAIGE KENDIG LCSW (NPI 1700487071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700487071 NPI number — AMANDA PAIGE KENDIG LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENDIG
Provider First Name:
AMANDA
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700487071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 RIVERSIDE DRIVE, BUILDING 6
Provider Second Line Business Mailing Address:
SUITE 100E
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-858-6775
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 RIVERSIDE DR BLDG 6
Provider Second Line Business Practice Location Address:
STE 100E
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75039-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-813-8378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2020

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: 1041C0700X , with the licence number:  60638 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60638 . This is a "LCSW LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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