Healthcare Provider Details

I. General information

NPI: 1386158442
Provider Name (Legal Business Name): BRITTANY PERDUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY KILGOUR

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 FULTON AVE
CINCINNATI OH
45206-2504
US

IV. Provider business mailing address

5981 N TURTLE CREEK DR
FAIRFIELD OH
45014-5137
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-4663
  • Fax: 513-818-4680
Mailing address:
  • Phone: 513-226-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number150585
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: