Healthcare Provider Details

I. General information

NPI: 1134033194
Provider Name (Legal Business Name): REBECCA KIRKHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 FRAMINGTON CT
INDIANAPOLIS IN
46254-9675
US

IV. Provider business mailing address

4616 FRAMINGTON CT
INDIANAPOLIS IN
46254-9675
US

V. Phone/Fax

Practice location:
  • Phone: 317-452-3549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006531A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number10087988
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: