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NPI Code Detail

MEDICARE: KATHLEEN R ANDERSON LISW-S LLC

MEDICARE: KATHLEEN R ANDERSON LISW-S LLC
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 WorkerI0700139OH

General Provider Information

NPI Number : 1831527977
Entity Type Code : Organization
Provider Name (Legal Business Name) : KATHLEEN R ANDERSON LISW-S LLC
Provider Business Mailing Address
First Line : 7960 CLYO RD
Second Line :
City : DAYTON
State : OH
Zip : 45459-4835
Country : US
Telephone Number : 937-439-2984
Fax Number : 937-439-4429
Provider Business Practice Location Address
First Line : 1055 E CENTERVILLE STATION RD
Second Line :
City : DAYTON
State : OH
Zip : 45459-5500
Country : US
Telephone Number : 937-439-2984
Fax Number : 937-439-4429
Authorized Official
Title or Position : OWNER/PROVIDER
Name : KATHLEEN R ANDERSON
Credential : LISW-S
Telephone Number : 937-231-5074
Provider Enumeration Date : 10/29/2013
Last Update Date : 09/27/2023

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