Provider Demographics
NPI:1467045609
Name:KOSTELNIK, KIM (LISW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:KOSTELNIK
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 1:5773 BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7355
Mailing Address - Country:US
Mailing Address - Phone:614-940-6742
Mailing Address - Fax:
Practice Address - Street 1:5773 BARBARA DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7355
Practice Address - Country:US
Practice Address - Phone:614-940-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17002451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical