Provider Demographics
NPI:1306929773
Name:MCLENDON, TODD LYNN (LMP)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:LYNN
Last Name:MCLENDON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:855 TROSPER RD SW # 108-133
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-8108
Mailing Address - Country:US
Mailing Address - Phone:360-789-5142
Mailing Address - Fax:360-352-8868
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:360-789-5142
Practice Address - Fax:360-352-8868
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014851225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist