Provider Demographics
NPI:1871903922
Name:POTSUBAY, KENDRA (MS/CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:
Last Name:POTSUBAY
Suffix:
Gender:F
Credentials:MS/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:PO BOX 247
Mailing Address - Street 2:145 NAIL ROAD
Mailing Address - City:EAU CLAIRE
Mailing Address - State:PA
Mailing Address - Zip Code:16030-0247
Mailing Address - Country:US
Mailing Address - Phone:724-991-8070
Mailing Address - Fax:
Practice Address - Street 1:393 ADAMS ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-2128
Practice Address - Country:US
Practice Address - Phone:724-774-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
PASL011251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health