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NPI Code Detail

MEDICARE: KYLA MARIE ARDISON LCSW

MEDICARE: KYLA MARIE ARDISON LCSW
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
11041C0700XClinical Social Worker137768CA

General Provider Information

NPI Number : 1083239479
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLA MARIE ARDISON LCSW
Provider Business Mailing Address
First Line : 3075 MYERS ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-5525
Country : US
Telephone Number : 951-358-6895
Fax Number :
Provider Business Practice Location Address
First Line : 3075 MYERS ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-5525
Country : US
Telephone Number : 951-358-6895
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2020
Last Update Date : 04/07/2026

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Directions to “ KYLA MARIE ARDISON LCSW” Practice Location

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