Provider Demographics
NPI:1154528255
Name:ANDERSON, KARY (LISW)
Entity type:Individual
Prefix:MISS
First Name:KARY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-0765
Mailing Address - Country:US
Mailing Address - Phone:330-345-7949
Mailing Address - Fax:330-345-5218
Practice Address - Street 1:1590 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3560
Practice Address - Country:US
Practice Address - Phone:419-289-0970
Practice Address - Fax:419-289-8579
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI07001581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10042Medicaid