Provider Demographics
NPI:1215253505
Name:KAISHER, KIMBERLY MARY (LCSW, LCAC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARY
Last Name:KAISHER
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 DOCTORS PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2376
Mailing Address - Country:US
Mailing Address - Phone:812-565-9318
Mailing Address - Fax:812-379-8020
Practice Address - Street 1:1950 DOCTORS PARK DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2376
Practice Address - Country:US
Practice Address - Phone:812-565-9318
Practice Address - Fax:812-379-8020
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005904A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical