Provider Demographics
NPI:1265110761
Name:VANHOOSE, MIKAYLA NICOLE (LGSW)
Entity type:Individual
Prefix:MRS
First Name:MIKAYLA
Middle Name:NICOLE
Last Name:VANHOOSE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2151
Mailing Address - Country:US
Mailing Address - Phone:740-861-4264
Mailing Address - Fax:
Practice Address - Street 1:888 OAKWOOD RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2071
Practice Address - Country:US
Practice Address - Phone:681-265-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
WVBP00946581104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No376J00000XNursing Service Related ProvidersHomemaker