Kendall Basore, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801100387 Issued in MI

Practice address

445 S. Landmark Ave.
Bloomington, IN 47403

Phone

(812) 353-3450

Fax

(812) 353-3451

NPI assigned

Oct 26, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1104170232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 S. LANDMARK AVE.",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47403",
            "telephone_number": "812-353-3450",
            "fax_number": "812-353-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 S. LANDMARK AVE.",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47403",
            "telephone_number": "812-353-3450",
            "fax_number": "812-353-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASORE",
        "first_name": "KENDALL",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-26",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34006602A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801100387",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801100387",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Baseline Logic LLC
• Baseline Logic LLC
• Baseline Logic LLC
• Tabitha Ann Basham
• Christine Basile
• Kelly Bassemier
• Sarah Bassett
• Catherine Elizabeth Batka, PH.D.
• Elizabeth Batteiger, RBT
• Kyle Bauer, BS

• Clinical Social Worker in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.