Healthcare Provider Details

I. General information

NPI: 1265780613
Provider Name (Legal Business Name): ELIZABETH ANN KAHL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CARNEGIE AVE
CLEVELAND OH
44115-2641
US

IV. Provider business mailing address

7701 N LAMAR BLVD STE 206
AUSTIN TX
78752-1022
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-8900
  • Fax:
Mailing address:
  • Phone: 440-234-2006
  • Fax: 440-234-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1200771
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number62853
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: