Provider Demographics
NPI:1225178239
Name:GANT, KATHI (LISW)
Entity Type:Individual
Prefix:MS
First Name:KATHI
Middle Name:
Last Name:GANT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-0302
Mailing Address - Country:US
Mailing Address - Phone:440-247-7088
Mailing Address - Fax:440-891-0711
Practice Address - Street 1:17535 ROSBOUGH BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8361
Practice Address - Country:US
Practice Address - Phone:440-891-9177
Practice Address - Fax:440-891-0711
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00053441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P27102Medicare UPIN
OHGASW23371Medicare ID - Type Unspecified