Individual
TABITHA ANN FENDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801091940
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8072-123
STATE OF WISCONSIN DSPS
WI
01
—
TF085506
BCBS OF MI
MI
Enumeration date
10/02/2006
Last updated
10/11/2013
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