Kendall Basore, MSW, LCSW
Social Worker, Clinical in Bloomington, IN. Individual provider (NPI-1).
NPI number1104170232
StatusActive
Last updated in NPPESDec 16, 2020
Details
- NPI
- 1104170232
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Kendall Basore
- Credential
- MSW, LCSW
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 26, 2012
- Certification date
- Dec 16, 2020
- Last updated
- Dec 16, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 6801100387 | MI | Yes |
| 1041C0700X | Social Worker, Clinical | 34006602A | IN | |
| 104100000X | Social Worker | 6801100387 | MI |
Practice location
445 S. Landmark Ave.Bloomington, IN 47403
Phone 812-353-3450 · Fax 812-353-3451
Mailing address
445 S. Landmark Ave.Bloomington, IN 47403
Phone 812-353-3450 · Fax 812-353-3451
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