=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093524068
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLA SCHUSTER LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2025
-----------------------------------------------------
Last Update Date | 01/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 S STATE ST STE A
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-971-0678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 812 COSHOCTON AVE # 155
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43050-1947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-971-0678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | S.2208573
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------