Healthcare Provider Details

I. General information

NPI: 1902762404
Provider Name (Legal Business Name): LAKEISHA MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 CHEVIOT RD
CINCINNATI OH
45247-7003
US

IV. Provider business mailing address

8309 KINGSMERE CT
CINCINNATI OH
45231-6007
US

V. Phone/Fax

Practice location:
  • Phone: 513-740-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: