Healthcare Provider Details

I. General information

NPI: 1568606762
Provider Name (Legal Business Name): KRISTEN LOWE-BROWNING LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 ALLANBY DRIVE
MARYSVILLE OH
43004
US

IV. Provider business mailing address

453 ALLANBY DRIVE
MARYSVILLE OH
43004
US

V. Phone/Fax

Practice location:
  • Phone: 937-642-0048
  • Fax: 937-642-1316
Mailing address:
  • Phone: 937-642-0048
  • Fax: 937-642-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0008330
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: