Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | I.0004042 | OH |
NPI | 1003034463 |
---|---|
Provider Name | Kevin L Cline |
First Address | Kent, OH 44240-6260 |
Second Address | Ravenna, OH 44266-2218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |