Healthcare Provider Details

I. General information

NPI: 1093525743
Provider Name (Legal Business Name): SOPHIA KISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 ROCKY RIVER DR
CLEVELAND OH
44111-4153
US

IV. Provider business mailing address

26513 GLENCOVE TRL
COLUMBIA STATION OH
44028-9835
US

V. Phone/Fax

Practice location:
  • Phone: 440-725-7434
  • Fax:
Mailing address:
  • Phone: 440-725-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2305400
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: