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General NPI Number Information
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NPI Number | 1508454828
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Entity Type | Individual
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Provider Name | KAITLYN PAIGE BOBER
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Gender | Female
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Dates
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Enumeration Date | 01/03/2021
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Last Update Date | 01/03/2021
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Provider Practice Location Address
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Address Line | 20575 CENTER RIDGE RD STE 318
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City | ROCKY RIVER
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State | OH
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Zip | 44116-3422
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Country | US
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Telephone | 216-563-1661
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Fax |
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Provider Business Mailing Address
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Address Line | 6205 HICKORY TRL
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City | NORTH RIDGEVILLE
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State | OH
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Zip | 44039-2658
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Country | US
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Telephone | 440-420-2912
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2002806-TRNE
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License Number State | OH
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