Provider Demographics
NPI:1922621317
Name:LILES, KIERSTIN (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:KIERSTIN
Middle Name:
Last Name:LILES
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 COUNTY ROAD 23 N
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:OH
Mailing Address - Zip Code:43343-9730
Mailing Address - Country:US
Mailing Address - Phone:937-935-9235
Mailing Address - Fax:
Practice Address - Street 1:131 OAK MEADOW DR STE 102
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-9812
Practice Address - Country:US
Practice Address - Phone:614-835-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker