Healthcare Provider Details

I. General information

NPI: 1174989347
Provider Name (Legal Business Name): KATHLEEN KAUFFMAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 04/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 LASLEY DR
LEBANON IN
46052-1480
US

IV. Provider business mailing address

5101 E US HIGHWAY 36 STE 100
AVON IN
46123-6646
US

V. Phone/Fax

Practice location:
  • Phone: 765-482-7421
  • Fax:
Mailing address:
  • Phone: 888-714-1927
  • Fax: 317-745-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008477A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: