Provider Demographics
NPI:1962399162
Name:BLACKGRAVE, KENDYL GRACE (RBT)
Entity type:Individual
Prefix:
First Name:KENDYL
Middle Name:GRACE
Last Name:BLACKGRAVE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TUTOR LN STE 107
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7295
Mailing Address - Country:US
Mailing Address - Phone:812-602-1038
Mailing Address - Fax:812-602-1048
Practice Address - Street 1:900 TUTOR LN STE 107
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7295
Practice Address - Country:US
Practice Address - Phone:812-602-1038
Practice Address - Fax:812-602-1048
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-25-440731106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician