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NPI Code Detail

MEDICARE: ETHAN L KISER E.2606146

MEDICARE: ETHAN L KISER E.2606146
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
1101Y00000XCounselorE.2606146OH

General Provider Information

NPI Number : 1144989377
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN L KISER E.2606146
Provider Business Mailing Address
First Line : 1205 BROADWAY
Second Line :
City : LORAIN
State : OH
Zip : 44052-3409
Country : US
Telephone Number : 440-240-1655
Fax Number :
Provider Business Practice Location Address
First Line : 1205 BROADWAY
Second Line :
City : LORAIN
State : OH
Zip : 44052-3409
Country : US
Telephone Number : 440-240-1655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2021
Last Update Date : 01/16/2026

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Directions to “ ETHAN L KISER E.2606146” Practice Location

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