Provider Demographics
NPI:1447475710
Name:BRYNJOLFSSON, KENNETH LEE (EDD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEE
Last Name:BRYNJOLFSSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 TURQUOISE CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3343
Mailing Address - Country:US
Mailing Address - Phone:530-604-4192
Mailing Address - Fax:530-243-6247
Practice Address - Street 1:504 TURQUOISE CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3343
Practice Address - Country:US
Practice Address - Phone:530-604-4192
Practice Address - Fax:530-243-6247
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 3938103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities