MEDICARE: KELLEY RASCHKE 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
1	1041C0700X	Clinical Social Worker	I.0009992-SUPV	OH

General Provider Information

NPI Number	:	1083702880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY RASCHKE LISW

Provider Business Mailing Address
First Line	:	4240 N GENSEN LOOP
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-7028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4240 N GENSEN LOOP
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-7028
Country	:	US
Telephone Number	:	513-507-3101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	02/05/2026

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Directions to “ KELLEY RASCHKE LISW” Practice Location

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