MEDICARE: KIMBERLY HAYES 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	254107	KY
2	1041C0700X	Clinical Social Worker	I.2203857	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508316258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HAYES LISW

Provider Business Mailing Address
First Line	:	1018 E NEW CIRCLE RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4145
Country	:	US
Telephone Number	:	859-428-7627
Fax Number	:	859-479-3228

Provider Business Practice Location Address
First Line	:	8040 HOSBROOK RD STE 102
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2908
Country	:	US
Telephone Number	:	859-359-2004
Fax Number	:

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

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	01/17/2024

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Directions to “ KIMBERLY HAYES LISW” Practice Location

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