Provider Demographics
NPI:1134615594
Name:KENDALL, TRESSA (LBSW)
Entity type:Individual
Prefix:
First Name:TRESSA
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:TRESSA
Other - Middle Name:
Other - Last Name:LICKFELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:1199 HARRIS AVENUE
Mailing Address - Street 2:PO BOX 310
Mailing Address - City:TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48763-0310
Mailing Address - Country:US
Mailing Address - Phone:989-362-8636
Mailing Address - Fax:989-362-7800
Practice Address - Street 1:5805 CEDAR LAKE RD
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-9499
Practice Address - Country:US
Practice Address - Phone:989-739-1469
Practice Address - Fax:989-739-9901
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802084930104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker