Healthcare Provider Details

I. General information

NPI: 1396159059
Provider Name (Legal Business Name): KIMBERLY LYNN SMALLWOOD MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EAST TOWNSEND STREET
NORTH LEWISBURG OH
43060-9777
US

IV. Provider business mailing address

135 E TOWNSEND ST
NORTH LEWISBURG OH
43060-9777
US

V. Phone/Fax

Practice location:
  • Phone: 937-935-3028
  • Fax: 937-612-4097
Mailing address:
  • Phone: 937-642-1065
  • Fax: 937-642-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI. 0009151 SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: