Provider Demographics
NPI:1477730364
Name:MCLENDON, TAMMY (LMP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 COLBY AVE
Mailing Address - Street 2:#897
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4773
Mailing Address - Country:US
Mailing Address - Phone:425-210-3549
Mailing Address - Fax:
Practice Address - Street 1:8227 44TH AVE W
Practice Address - Street 2:SUITE E
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-2815
Practice Address - Country:US
Practice Address - Phone:425-210-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist