Provider Demographics
NPI:1538421441
Name:LONG, KENDRA MICHELE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:MICHELE
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 S BEECH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:MO
Mailing Address - Zip Code:64485-2107
Mailing Address - Country:US
Mailing Address - Phone:816-262-5494
Mailing Address - Fax:
Practice Address - Street 1:1106 S BEECH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:MO
Practice Address - Zip Code:64485-2107
Practice Address - Country:US
Practice Address - Phone:816-262-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140385211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical