=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528391851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANE P. KALLIO, LCSW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2009
-----------------------------------------------------
Last Update Date | 01/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7605 FOREST AVE STE 414
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-4941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-319-0128
-----------------------------------------------------
Fax | 804-592-5301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7605 FOREST AVE STE 414
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-4941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-319-0128
-----------------------------------------------------
Fax | 804-592-5301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JANE PHYLLIS KALLIO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 804-319-0128
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904004667
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------