Provider Demographics
NPI:1457618332
Name:LAUGHLIN, KYLIE S (LISW)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:S
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:S
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:1479 N RIVER RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9760
Practice Address - Country:US
Practice Address - Phone:419-355-9440
Practice Address - Fax:419-355-9443
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0900367104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHH110570Medicare PIN