| Doctor Name: | MANDIE BOLTON KENDER |
| NPI Number: | 1194034579 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 179584 |
| Business Practice Address: | 1740 Livingston Ave West Saint Paul, MN - 551183912 |
| Business Phone Number: | 6514572248 |
| Business Fax Number: | |
| Mailing Address: | 11 Marquette Ave, #601 MINNEAPOLIS |
| State: | MN |
| Postal Code: | 55401 |
| Phone Number: | 6122324321 |
| Fax Number: | |
| NPI Enumeration Date: | 10/01/2010 |
| NPI Last Update Date: | 10/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TR0400X |
| License Number: | 179584 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |