Basic Information
| Provider Information | |||||||||
| NPI: | 1487848073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEEHAN | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | MARIE | ||||||||
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| OtherLastName: | FEEHAN | ||||||||
| OtherFirstName: | KIM | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | LSW., MSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 410 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | STRYKER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435579100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196827891 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7320 STATE HIGHWAY 108 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WAUSEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435678200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193353732 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 08/28/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S0500354 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.