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Individual
JONATHAN A KALLIS
Active
Individual
JONATHAN A KALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
I0009706
OH
1041C0700X
Clinical Social Worker
Primary
82079
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8200117300
—
KY
Enumeration date
06/05/2006
Last updated
06/30/2022
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