Provider Demographics
NPI:1689065054
Name:BRINK, KENDRA L (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:L
Last Name:BRINK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 W CENTER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3134
Mailing Address - Country:US
Mailing Address - Phone:402-391-5002
Mailing Address - Fax:402-343-1278
Practice Address - Street 1:8031 W CENTER RD STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3134
Practice Address - Country:US
Practice Address - Phone:402-391-5002
Practice Address - Fax:402-343-1278
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011796235Z00000X
NE1968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist