Provider Demographics
NPI:1457014367
Name:CHESTER, KYLE LEE (BS)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:LEE
Last Name:CHESTER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2918
Mailing Address - Country:US
Mailing Address - Phone:859-533-7556
Mailing Address - Fax:
Practice Address - Street 1:2434 RICHMILLER LN UNIT F
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1075
Practice Address - Country:US
Practice Address - Phone:304-918-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty