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NPI Code Detail

MEDICARE: KENNETH RICHARD KLOSS M.S.W.,L.I.S.W.

MEDICARE: KENNETH RICHARD KLOSS M.S.W.,L.I.S.W.
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 WorkerI - 0001719OH

General Provider Information

NPI Number : 1710190038
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH RICHARD KLOSS M.S.W.,L.I.S.W.
Provider Business Mailing Address
First Line : 3915 BRIGGS PL
Second Line :
City : CINCINNATI
State : OH
Zip : 45209-1905
Country : US
Telephone Number : 513-531-8817
Fax Number : 513-985-2182
Provider Business Practice Location Address
First Line : 7826 COOPER RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45242-7619
Country : US
Telephone Number : 513-984-1000
Fax Number : 513-985-2182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 07/08/2007

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