Healthcare Provider Details

I. General information

NPI: 1902571524
Provider Name (Legal Business Name): BOBBI KRAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 ALEXANDRIA PIKE
HIGHLAND HEIGHTS KY
41076-1530
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-5901
  • Fax: 859-301-5940
Mailing address:
  • Phone: 859-301-5901
  • Fax: 859-301-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number255905
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255905
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: