Healthcare Provider Details

I. General information

NPI: 1972058873
Provider Name (Legal Business Name): CLARK COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 SHOPPERS DR
WINCHESTER KY
40391-2806
US

IV. Provider business mailing address

400 PROFESSIONAL AVE
WINCHESTER KY
40391-1147
US

V. Phone/Fax

Practice location:
  • Phone: 859-745-7995
  • Fax: 859-745-0115
Mailing address:
  • Phone: 859-745-7995
  • Fax: 859-745-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. REBECCA A KISSICK
Title or Position: PUBLIC HEALTH DIRECTOR
Credential:
Phone: 859-744-4482