Provider Demographics
NPI:1053720409
Name:SHIFFMAN, KENDRA (MS)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:SHIFFMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N STATE ST
Mailing Address - Street 2:UNIT 1906
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 N STATE ST
Practice Address - Street 2:UNIT 1906
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-7574
Practice Address - Country:US
Practice Address - Phone:785-821-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010612235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist