Provider Demographics
NPI:1619244381
Name:KENDALL, SASHA (LCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47701-0033
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:15 VANN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1444
Practice Address - Country:US
Practice Address - Phone:812-402-8333
Practice Address - Fax:812-402-8331
Is Sole Proprietor?:No
Enumeration Date:2011-11-24
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005506A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000861030OtherANTHEM BCBS
P01450026OtherRAILROAD MEDICARE
P01450026OtherRAILROAD MEDICARE