MEDICARE: MS. KATHLEEN FRANCES COONEY LISW, LICDC

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	I0008194	OH

General Provider Information

NPI Number	:	1588764575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN FRANCES COONEY LISW, LICDC

Provider Business Mailing Address
First Line	:	9 WHITAKER CV
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-2349
Country	:	US
Telephone Number	:	440-930-8108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3416 COLUMBUS AVE
Second Line	:	SANDUSKY OUTPATIENT CLINIC 3RD FLOOR
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5557
Country	:	US
Telephone Number	:	419-625-7350
Fax Number	:	419-625-6660

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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