Healthcare Provider Details

I. General information

NPI: 1225942279
Provider Name (Legal Business Name): KALIYAH LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S WHEELING ST
OREGON OH
43616-2014
US

IV. Provider business mailing address

1905 PERRYSBURG HOLLAND RD
HOLLAND OH
43528-8630
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-3406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: