MEDICARE: KELLIE SUE COLE 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
1	104100000X	Social Worker	S1600146	OH

General Provider Information

NPI Number	:	1588509822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE SUE COLE LSW

Provider Business Mailing Address
First Line	:	130B MORGAN AVE APT B
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-4822
Country	:	US
Telephone Number	:	740-522-8477
Fax Number	:

Provider Business Practice Location Address
First Line	:	130B MORGAN AVE APT B
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-4822
Country	:	US
Telephone Number	:	740-522-8477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/23/2026

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Directions to “ KELLIE SUE COLE LSW” Practice Location

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