Provider Demographics
NPI:1326488792
Name:KUSHNER, KELLIE ANN (LISW)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANN
Last Name:KUSHNER
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 1:1080 NIMITZVIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4300
Mailing Address - Country:US
Mailing Address - Phone:513-233-0020
Mailing Address - Fax:
Practice Address - Street 1:1080 NIMITZVIEW DR STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4300
Practice Address - Country:US
Practice Address - Phone:513-233-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1200903104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker