Provider Demographics
NPI:1114347614
Name:KITZMILLER, KRISTIN (LISW-SUPV)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KITZMILLER
Suffix:
Gender:F
Credentials:LISW-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 E DARTMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2429
Mailing Address - Country:US
Mailing Address - Phone:330-571-0545
Mailing Address - Fax:
Practice Address - Street 1:773 E DARTMOOR AVE
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-2429
Practice Address - Country:US
Practice Address - Phone:330-571-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0800006-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical