Healthcare Provider Details

I. General information

NPI: 1760911648
Provider Name (Legal Business Name): KYTARA N REDDICK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 UNIVERSITY SQ STE 30
HUNTSVILLE AL
35816-1829
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 256-489-0170
  • Fax: 256-489-0179
Mailing address:
  • Phone: 419-695-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4493C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: