=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972130417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHRYN A BIDDLE KATEBIDDLELLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2020
-----------------------------------------------------
Last Update Date | 03/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2655 DODD RD
-----------------------------------------------------
City | WILLOUGHBY HILLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44094-9652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-667-7353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2655 DODD RD
-----------------------------------------------------
City | WILLOUGHBY HILLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44094-9652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | KATHRYN A BIDDLE
-----------------------------------------------------
Credential | LISW-S
-----------------------------------------------------
Telephone | 440-667-7353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------