Healthcare Provider Details

I. General information

NPI: 1417879230
Provider Name (Legal Business Name): KELSEY JORDAN VICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 NORWOOD AVE APT 2
CINCINNATI OH
45212-2728
US

IV. Provider business mailing address

2604 NORWOOD AVE APT 2
CINCINNATI OH
45212-2728
US

V. Phone/Fax

Practice location:
  • Phone: 513-279-2772
  • Fax:
Mailing address:
  • Phone: 513-279-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506869
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: