Provider Demographics
NPI:1255718649
Name:WHIPPLE, KYLA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 BOB O LINK DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1338
Mailing Address - Country:US
Mailing Address - Phone:941-685-3716
Mailing Address - Fax:
Practice Address - Street 1:333 TAMIAMI TRL S STE 284
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2441
Practice Address - Country:US
Practice Address - Phone:941-363-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW99761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014827200Medicaid