Healthcare Provider Details

I. General information

NPI: 1962900282
Provider Name (Legal Business Name): LINDA KOKENGE LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 MADISON RD
CINCINNATI OH
45227-1491
US

IV. Provider business mailing address

3493 SMITHFIELD LN
CINCINNATI OH
45239-3826
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-2800
  • Fax:
Mailing address:
  • Phone: 513-349-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: