MEDICARE: KATLYN SHORT MSW, LISW-S

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720497548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATLYN SHORT MSW, LISW-S

Provider Business Mailing Address
First Line	:	1054 S WASHINGTON ST STE B
Second Line	:
City	:	VAN WERT
State	:	OH
Zip	:	45891-1476
Country	:	US
Telephone Number	:	419-238-1000
Fax Number	:	419-238-1071

Provider Business Practice Location Address
First Line	:	1054 S WASHINGTON ST STE B
Second Line	:
City	:	VAN WERT
State	:	OH
Zip	:	45891-1476
Country	:	US
Telephone Number	:	419-238-1000
Fax Number	:	419-238-1071

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	06/01/2026

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