Provider Demographics
NPI:1972150118
Name:TAULBEE, KRISTIN JOAN (SWT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JOAN
Last Name:TAULBEE
Suffix:
Gender:F
Credentials:SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 LAYMON RD
Mailing Address - Street 2:
Mailing Address - City:NEW VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45159-9550
Mailing Address - Country:US
Mailing Address - Phone:937-657-3300
Mailing Address - Fax:
Practice Address - Street 1:136 HEID AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1218
Practice Address - Country:US
Practice Address - Phone:937-253-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1610514-TRNE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.1610514-TRNEOtherSOCIAL WORKER TRAINEE