Provider Demographics
NPI:1407005804
Name:ANDERSON, KATHLEEN RHODES (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RHODES
Last Name:ANDERSON
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 1:1055 E CENTERVILLE STATION RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5500
Mailing Address - Country:US
Mailing Address - Phone:937-439-2984
Mailing Address - Fax:937-439-2984
Practice Address - Street 1:1055 E CENTERVILLE STATION RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-5500
Practice Address - Country:US
Practice Address - Phone:937-439-2984
Practice Address - Fax:937-439-2984
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700139.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical