Provider Demographics
NPI:1770875510
Name:ROSSON, KENDALL (LCSW)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:ROSSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74402-1267
Mailing Address - Country:US
Mailing Address - Phone:918-463-2581
Mailing Address - Fax:918-463-2585
Practice Address - Street 1:1002 CAMPBELL ST.
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:OK
Practice Address - Zip Code:74469
Practice Address - Country:US
Practice Address - Phone:918-463-2581
Practice Address - Fax:918-463-2585
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53051041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical