Provider Demographics
NPI:1316705304
Name:MCCLENDON, JABARI TARIQ (CRT)
Entity type:Individual
Prefix:MR
First Name:JABARI
Middle Name:TARIQ
Last Name:MCCLENDON
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 SPINNAKER LN
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3163
Mailing Address - Country:US
Mailing Address - Phone:757-270-6181
Mailing Address - Fax:
Practice Address - Street 1:5114 SPINNAKER LN
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3163
Practice Address - Country:US
Practice Address - Phone:757-270-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0117009294227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified