Provider Demographics
NPI:1699459370
Name:KENT, KYLIE (LMSW)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:KENT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-1405
Mailing Address - Country:US
Mailing Address - Phone:641-872-1750
Mailing Address - Fax:
Practice Address - Street 1:102 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1405
Practice Address - Country:US
Practice Address - Phone:641-872-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1189671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical