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NPI Code Detail

MEDICARE: KELLY MULQUEEN LISW

MEDICARE: KELLY MULQUEEN 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
11041C0700XClinical Social WorkerI9301OH

General Provider Information

NPI Number : 1124104914
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MULQUEEN LISW
Provider Business Mailing Address
First Line : 223 MILLER RD
Second Line :
City : AVON LAKE
State : OH
Zip : 44012-1004
Country : US
Telephone Number : 440-930-2002
Fax Number : 440-930-2085
Provider Business Practice Location Address
First Line : 223 MILLER RD
Second Line :
City : AVON LAKE
State : OH
Zip : 44012-1004
Country : US
Telephone Number : 440-930-2002
Fax Number : 440-930-2085
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 07/08/2007

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1952487712 — DR. SAID N ABOU HAIDAR MD
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1265518047 — SETH NIEDING LISW
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Directions to “ KELLY MULQUEEN LISW” Practice Location

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