Individual
KIRSTEN LYSETTE VAN KALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2651 BURNET AVE, CINCINNATI, OH 45219-2551
(323) 541-5814
(323) 541-5814
Mailing address
5549 REGIMENTAL PL, CINCINNATI, OH 45239-6718
(323) 541-5814
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-12822
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP-12822
OHIO STATE BOARD
OH
Enumeration date
10/11/2017
Last updated
10/11/2017
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