Provider Demographics
NPI:1316495898
Name:RUPP, KAYLA (LISW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:RUPP
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:DEPT 781625 PO BOX 78000
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1625
Mailing Address - Country:US
Mailing Address - Phone:143-558-0046
Mailing Address - Fax:
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5369
Practice Address - Country:US
Practice Address - Phone:614-355-6340
Practice Address - Fax:614-355-6347
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18010941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid