Provider Demographics
NPI:1902845175
Name:PRICE, KIM M (LISW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:PRICE
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 1:1159 INVERNESS LN
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2267
Mailing Address - Country:US
Mailing Address - Phone:330-928-9527
Mailing Address - Fax:
Practice Address - Street 1:1159 INVERNESS LN
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2267
Practice Address - Country:US
Practice Address - Phone:330-928-9527
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00046821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPRSW18676Medicare PIN