Healthcare Provider Details

I. General information

NPI: 1922881655
Provider Name (Legal Business Name): KAYLA MARIE KLOTZ LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 INDIANOLA AVE
COLUMBUS OH
43201-2118
US

IV. Provider business mailing address

368 ALDEN AVE
COLUMBUS OH
43201-1393
US

V. Phone/Fax

Practice location:
  • Phone: 614-294-2661
  • Fax:
Mailing address:
  • Phone: 419-603-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: