MEDICARE: KRISTIN MCALLISTER 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	104100000X	Social Worker	I.1901856-SUPV	OH
2	1041C0700X	Clinical Social Worker	S.1101092	OH

General Provider Information

NPI Number	:	1881105435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MCALLISTER LISW-S

Provider Business Mailing Address
First Line	:	2321 TAYLOR PARK DR # 1109
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-8052
Country	:	US
Telephone Number	:	614-595-2077
Fax Number	:	949-543-2708

Provider Business Practice Location Address
First Line	:	2321 TAYLOR PARK DR # 1109
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-8052
Country	:	US
Telephone Number	:	614-595-2077
Fax Number	:	949-543-2708

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

Provider Enumeration Date	:	10/22/2017
Last Update Date	:	01/17/2025

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