Provider Demographics
NPI:1902133986
Name:CHISHOLM, KATHRYN LYNN (LISW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LYNN
Last Name:CHISHOLM
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 1:1325 CONFERENCE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-8009
Mailing Address - Country:US
Mailing Address - Phone:419-383-6431
Mailing Address - Fax:419-383-2922
Practice Address - Street 1:1325 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8009
Practice Address - Country:US
Practice Address - Phone:419-383-6431
Practice Address - Fax:419-383-2922
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 1302882-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical