Healthcare Provider Details

I. General information

NPI: 1255718649
Provider Name (Legal Business Name): KYLA WHIPPLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 TAMIAMI TRL S STE 284
VENICE FL
34285-2441
US

IV. Provider business mailing address

1636 BOB O LINK DR
VENICE FL
34293-1338
US

V. Phone/Fax

Practice location:
  • Phone: 941-363-1558
  • Fax:
Mailing address:
  • Phone: 941-685-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: