Healthcare Provider Details

I. General information

NPI: 1922743277
Provider Name (Legal Business Name): KIM ANN KAVANSHANSKY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM ANN SCHUESSLER LSW

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 LOCH LOMOND ST
UNIONTOWN PA
15401-4067
US

IV. Provider business mailing address

24 LOCH LOMOND ST
UNIONTOWN PA
15401-4067
US

V. Phone/Fax

Practice location:
  • Phone: 724-984-2494
  • Fax:
Mailing address:
  • Phone: 724-984-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW022334
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: