Healthcare Provider Details

I. General information

NPI: 1700301041
Provider Name (Legal Business Name): KATLIN CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 AICHOLTZ RD
CINCINNATI OH
45244-1447
US

IV. Provider business mailing address

4633 AICHOLTZ RD
CINCINNATI OH
45244-1447
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone: 513-752-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1901960
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: