Individual
MRS. KENDALL BASORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
445 S. LANDMARK AVE., BLOOMINGTON, IN 47403
(812) 353-3450
(812) 353-3451
Mailing address
445 S. LANDMARK AVE., BLOOMINGTON, IN 47403
(812) 353-3450
(812) 353-3451
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801100387
MI
1041C0700X
Clinical Social Worker
34006602A
IN
1041C0700X
Clinical Social Worker
Primary
6801100387
MI
Other
Enumeration date
10/26/2012
Last updated
12/16/2020
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