Healthcare Provider Details

I. General information

NPI: 1487029641
Provider Name (Legal Business Name): KESHA BLUNT-WILLIAMS LSW, CA-CYFSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KESHA BLUNT LSW, CA-CYFSW

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4724 VINE ST
CINCINNATI OH
45217-1254
US

IV. Provider business mailing address

4724 VINE ST
CINCINNATI OH
45217-1254
US

V. Phone/Fax

Practice location:
  • Phone: 513-349-1440
  • Fax: 513-482-7993
Mailing address:
  • Phone: 513-349-1440
  • Fax: 513-482-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS. 0027922
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberS.0027922
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberS. 0027922
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberS.0027922
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberS. 0027922
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberS. 0027922
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: