Provider Demographics
NPI:1679399885
Name:TINDLE, KENNEDI ANN
Entity type:Individual
Prefix:
First Name:KENNEDI
Middle Name:ANN
Last Name:TINDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9961 GRAYFIELD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1425
Mailing Address - Country:US
Mailing Address - Phone:313-848-1326
Mailing Address - Fax:
Practice Address - Street 1:31557 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1849
Practice Address - Country:US
Practice Address - Phone:734-607-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician