Provider Demographics
NPI:1720860174
Name:MCLENDON, AISSA V (CSW)
Entity Type:Individual
Prefix:
First Name:AISSA
Middle Name:V
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 OAKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8664
Mailing Address - Country:US
Mailing Address - Phone:224-388-9328
Mailing Address - Fax:
Practice Address - Street 1:210 MARIE LANGDON DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6388
Practice Address - Country:US
Practice Address - Phone:606-598-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
258519104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker