MEDICARE: KENDRA S DIDION LISW

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	0008621	OH

General Provider Information

NPI Number	:	1851519748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA S DIDION LISW

Provider Business Mailing Address
First Line	:	4317 STATE ROUTE 269 S
Second Line	:
City	:	CASTALIA
State	:	OH
Zip	:	44824-9354
Country	:	US
Telephone Number	:	419-684-9750
Fax Number	:	419-684-9760

Provider Business Practice Location Address
First Line	:	4317 STATE ROUTE 269 S
Second Line	:
City	:	CASTALIA
State	:	OH
Zip	:	44824-9354
Country	:	US
Telephone Number	:	419-684-9750
Fax Number	:	419-684-9760

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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Directions to “ KENDRA S DIDION LISW” Practice Location

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