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General NPI Number Information
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NPI Number | 1174249585
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Entity Type | Individual
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Provider Name | KIRSTEN LEE VANSLYKE LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 243 DELAWARE ST
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City | WALTON
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State | NY
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Zip | 13856-1019
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Country | US
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Telephone | 607-832-5889
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Fax |
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Provider Business Mailing Address
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Address Line | 318 FARNHAM RD
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City | WINDSOR
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State | NY
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Zip | 13865-2207
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Country | US
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Telephone | 607-761-9251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 116884-01
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License Number State | NY
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