| Kathleen R Anderson Lisw-s Llc | |
|
1055 E Centerville Station Rd Dayton OH 45459-5500 | |
| (937) 439-2984 | |
| (937) 439-4429 |
| Full Name | Kathleen R Anderson Lisw-s Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1055 E Centerville Station Rd, Dayton, Ohio |
| Authorized Official Name and Position | Kathleen R Anderson (OWNER/PROVIDER) |
| Authorized Official Contact | 9372315074 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathleen R Anderson Lisw-s Llc 7960 Clyo Rd Dayton OH 45459-4835 Ph: (937) 439-2984 | Kathleen R Anderson Lisw-s Llc 1055 E Centerville Station Rd Dayton OH 45459-5500 Ph: (937) 439-2984 |
| NPI Number | 1831527977 |
|---|---|
| Provider Enumeration Date | 10/29/2013 |
| Last Update Date | 09/27/2023 |
| Certification Date | 09/27/2023 |
| Medicare PECOS PAC ID | 3971732637 |
|---|---|
| Medicare Enrollment ID | O20140129001869 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831527977 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | I0700139 (Ohio) | Primary |
| Provider Name | Kathleen R Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407005804 PECOS PAC ID: 1355402728 Enrollment ID: I20081203000511 |
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