Provider Demographics
NPI:1447999248
Name:BRUNDRETT, KENDALL (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:BRUNDRETT
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5005
Mailing Address - Country:US
Mailing Address - Phone:858-413-5820
Mailing Address - Fax:
Practice Address - Street 1:2487 S GILBERT RD STE 106-153
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2807
Practice Address - Country:US
Practice Address - Phone:480-744-5286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000861103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst