=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083852362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARCELLA J KILLE LSCSW PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2009
-----------------------------------------------------
Last Update Date | 02/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E 1ST AVE
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67501-7147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-921-1029
-----------------------------------------------------
Fax | 620-662-5621
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 E 1ST AVE
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67501-7147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-921-1029
-----------------------------------------------------
Fax | 620-662-5621
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MARCELLA J KILLE
-----------------------------------------------------
Credential | LSCSW
-----------------------------------------------------
Telephone | 620-921-1029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 3862
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------