Provider Demographics
NPI:1821703166
Name:KULAKOSKI-HOERR, MARY (LISW-S)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KULAKOSKI-HOERR
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 1:681 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1625
Mailing Address - Country:US
Mailing Address - Phone:513-348-4788
Mailing Address - Fax:
Practice Address - Street 1:681 TYLER AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1625
Practice Address - Country:US
Practice Address - Phone:513-348-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0900117-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical