Provider Demographics
NPI:1043355902
Name:KENDALL, CHANTAL JACQUELINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:JACQUELINE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17682 MITCHELL N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614
Mailing Address - Country:US
Mailing Address - Phone:949-394-5057
Mailing Address - Fax:
Practice Address - Street 1:17682 MITCHELL N
Practice Address - Street 2:SUITE 104
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614
Practice Address - Country:US
Practice Address - Phone:949-394-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical