Provider Demographics
NPI:1881858413
Name:KIENE, ELAINE A (PCC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:A
Last Name:KIENE
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1216
Mailing Address - Country:US
Mailing Address - Phone:419-523-4300
Mailing Address - Fax:419-523-6188
Practice Address - Street 1:924 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1704
Practice Address - Country:US
Practice Address - Phone:419-969-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003929-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional