Healthcare Provider Details

I. General information

NPI: 1548718067
Provider Name (Legal Business Name): MELISSA KAISER LICDC-CS, LSW-MSW,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8963 KINGSRIDGE DR STE A
DAYTON OH
45458-1623
US

IV. Provider business mailing address

610 N MARSHALL RD
MIDDLETOWN OH
45042-3832
US

V. Phone/Fax

Practice location:
  • Phone: 513-464-9220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.021336
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number258344
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1500927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: