Healthcare Provider Details

I. General information

NPI: 1801985858
Provider Name (Legal Business Name): KRISTEN SUE EPPERSON LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W SPRUCE AVE
BYESVILLE OH
43723-9608
US

IV. Provider business mailing address

408 W SPRUCE AVE
BYESVILLE OH
43723-9608
US

V. Phone/Fax

Practice location:
  • Phone: 740-685-5453
  • Fax:
Mailing address:
  • Phone: 740-685-5453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0029680
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: