MEDICARE: KIMBERLY ZELLA HARRIS LISW-S

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.2102625	OH

General Provider Information

NPI Number	:	1114437852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ZELLA HARRIS LISW-S

Provider Business Mailing Address
First Line	:	3358 VILLAGE DR
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-8110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3358 VILLAGE DR
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-8110
Country	:	US
Telephone Number	:	513-919-6860
Fax Number	:

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

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	05/29/2025

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Directions to “ KIMBERLY ZELLA HARRIS LISW-S” Practice Location

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