Healthcare Provider Details

I. General information

NPI: 1245596527
Provider Name (Legal Business Name): KIERRA M OVERTON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 S MARGINAL RD
CLEVELAND OH
44103-1072
US

IV. Provider business mailing address

1801 WATERMARK DR STE 200
COLUMBUS OH
43215-7088
US

V. Phone/Fax

Practice location:
  • Phone: 614-487-8758
  • Fax: 614-227-9447
Mailing address:
  • Phone: 614-487-8758
  • Fax: 614-227-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1200318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: