Provider Demographics
NPI:1215538145
Name:CLENDENEN, EVA MAE
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MAE
Last Name:CLENDENEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-8411
Mailing Address - Country:US
Mailing Address - Phone:740-263-0496
Mailing Address - Fax:
Practice Address - Street 1:1095 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-4476
Practice Address - Country:US
Practice Address - Phone:740-848-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP407287347C00000X
3747P1801X
OHS.2208325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant