Healthcare Provider Details

I. General information

NPI: 1962367904
Provider Name (Legal Business Name): EMILY KATHLEEN LANKFORD PEER SUPPORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 1ST ST STE 200
DAYTON OH
45402-3026
US

IV. Provider business mailing address

301 W 1ST ST STE 200
DAYTON OH
45402-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-228-6590
  • Fax:
Mailing address:
  • Phone: 513-228-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number006792
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: