Doctor Name: | DR. GARY DANIEL KENDZIORSKI |
NPI Number: | 1730277617 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 1043-057 |
Business Practice Address: | 20943 W Good Hope Rd Lannon, WI - 530469770 |
Business Phone Number: | 2622503331 |
Business Fax Number: | |
Mailing Address: | 20943 W Good Hope Road, LANNON |
State: | WI |
Postal Code: | 53046 |
Phone Number: | 2622503331 |
Fax Number: | |
NPI Enumeration Date: | 10/10/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1043-057 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |