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NPI Code Detail

MEDICARE: KAITLIN MCKENZIE KONICEK LSW

MEDICARE: KAITLIN MCKENZIE KONICEK LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerS.1701703OH

General Provider Information

NPI Number : 1043728579
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLIN MCKENZIE KONICEK LSW
Provider Business Mailing Address
First Line : 9199 BRANDYWINE RD
Second Line :
City : NORTHFIELD
State : OH
Zip : 44067-2465
Country : US
Telephone Number : 216-598-0434
Fax Number :
Provider Business Practice Location Address
First Line : 23701 MILES RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-5473
Country : US
Telephone Number : 216-783-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2018
Last Update Date : 01/18/2018

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Directions to “ KAITLIN MCKENZIE KONICEK LSW” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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