MEDICARE: MS. CAILAN ELISE WALTERS LSW

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	171M00000X	Case Manager/Care Coordinator
2	1041C0700X	Clinical Social Worker	I.2304893	OH

General Provider Information

NPI Number	:	1952082307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAILAN ELISE WALTERS LSW

Provider Business Mailing Address
First Line	:	4045 LEESBURG LN APT 2
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-1518
Country	:	US
Telephone Number	:	812-212-3259
Fax Number	:

Provider Business Practice Location Address
First Line	:	463 S. BROADWAY ST.
Second Line	:
City	:	OWENSVILLE
State	:	OH
Zip	:	45160
Country	:	US
Telephone Number	:	513-728-3008
Fax Number	:

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

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	03/22/2024

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