Provider Demographics
NPI:1063992824
Name:KERNS, KAITLYN E (LSW)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:E
Last Name:KERNS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:E
Other - Last Name:WOLFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:595 LINN ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1404
Mailing Address - Country:US
Mailing Address - Phone:740-804-0742
Mailing Address - Fax:
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9718
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1701632104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker