Healthcare Provider Details

I. General information

NPI: 1093148587
Provider Name (Legal Business Name): KIMBERLY HAUSER LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY BRAUN

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 HUNT RD
BLUE ASH OH
45242-6612
US

IV. Provider business mailing address

533 COCHISE CT
WYOMING OH
45215-2519
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-0650
  • Fax:
Mailing address:
  • Phone: 513-891-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0026328
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: