Provider Demographics
NPI:1548718067
Name:KAISER, MELISSA (LICDC-CS, LSW-MSW,)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KAISER
Suffix:
Gender:F
Credentials:LICDC-CS, LSW-MSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8963 KINGSRIDGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45042-5035
Mailing Address - Country:US
Mailing Address - Phone:513-464-9220
Mailing Address - Fax:
Practice Address - Street 1:8963 KINGSRIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1623
Practice Address - Country:US
Practice Address - Phone:513-464-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY258344104100000X
OH1500927104100000X
OHLICDC.021336101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker