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General NPI Number Information
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NPI Number | 1740594530
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Entity Type | Individual
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Provider Name | KAYE ELLEN MAYNARD LISW
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Gender | Female
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 7257 E BROAD ST SW UNIT C
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City | PATASKALA
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State | OH
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Zip | 43062-8501
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Country | US
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Telephone | 740-963-2976
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 292
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City | PATASKALA
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State | OH
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Zip | 43062-0292
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Country | US
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Telephone | 740-963-2976
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Fax | 740-927-0461
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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 | I.1000063
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1000063
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License Number State | OH
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