MEDICARE: PHYLLIS KUEHNL PHD & ASSOC. INC.

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	103TC0700X	Clinical Psychologist	1966	OH

General Provider Information

NPI Number	:	1528065232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYLLIS KUEHNL PHD & ASSOC. INC.

Provider Business Mailing Address
First Line	:	14 REMICK BLVD
Second Line	:	STE 204
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-9168
Country	:	US
Telephone Number	:	937-886-9080
Fax Number	:	937-436-9408

Provider Business Practice Location Address
First Line	:	14 REMICK BLVD
Second Line	:	STE 204
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-9168
Country	:	US
Telephone Number	:	937-886-9080
Fax Number	:	937-436-9408

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. PHYLLIS ROSE KUEHNL-WALTERS
Credential	:	PHD
Telephone Number	:	937-886-9080

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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