Provider Demographics
NPI:1518580281
Name:BARD, KALIN ANN (CDCA)
Entity Type:Individual
Prefix:
First Name:KALIN
Middle Name:ANN
Last Name:BARD
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:KALIN
Other - Middle Name:ANN
Other - Last Name:SCARBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5231 SAUM ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-1818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1522 E US HIGHWAY 36 UNIT A
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9738
Practice Address - Country:US
Practice Address - Phone:937-471-2956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
OHCDCA.178041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist