MEDICARE: KAILYN JUTH LISW-S

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	I1901636	OH

General Provider Information

NPI Number	:	1811421472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILYN JUTH LISW-S

Provider Business Mailing Address
First Line	:	2100 N RIDGE RD
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-1241
Country	:	US
Telephone Number	:	440-324-1300
Fax Number	:	440-277-0409

Provider Business Practice Location Address
First Line	:	2100 N RIDGE RD
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-1241
Country	:	US
Telephone Number	:	440-324-1300
Fax Number	:	440-277-0409

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

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	08/18/2025

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