Provider Demographics
NPI:1083907190
Name:MCFALLS, KATHLEEN L (LISW-S)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:MCFALLS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 GATEWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1893
Mailing Address - Country:US
Mailing Address - Phone:513-234-7870
Mailing Address - Fax:513-234-7836
Practice Address - Street 1:5740 GATEWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1893
Practice Address - Country:US
Practice Address - Phone:513-234-7870
Practice Address - Fax:513-234-7836
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0024316104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH430460Medicare PIN