Healthcare Provider Details

I. General information

NPI: 1144726431
Provider Name (Legal Business Name): TYLER F KESSLER LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 GRANVILLE PL
DAYTON OH
45431-2704
US

IV. Provider business mailing address

630 GRANVILLE PL
DAYTON OH
45431-2704
US

V. Phone/Fax

Practice location:
  • Phone: 330-931-6528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2607728
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: