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NPI Code Detail

MEDICARE: KIM KOST LISW

MEDICARE: KIM KOST LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerI-0010036OH

General Provider Information

NPI Number : 1063625606
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM KOST LISW
Provider Business Mailing Address
First Line : 5982 RHODES RD
Second Line :
City : KENT
State : OH
Zip : 44240-4128
Country : US
Telephone Number : 330-673-1347
Fax Number : 330-678-3677
Provider Business Practice Location Address
First Line : 3920 LOVERS LN
Second Line :
City : RAVENNA
State : OH
Zip : 44266-4200
Country : US
Telephone Number : 330-673-1347
Fax Number : 330-678-3677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2007
Last Update Date : 07/08/2007

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Directions to “ KIM KOST LISW” Practice Location

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