Healthcare Provider Details

I. General information

NPI: 1104144989
Provider Name (Legal Business Name): PATRICIA LOUISE KUYKENDOLL PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 UNIVERSITY BLVD
HAMILTON OH
45011-3305
US

IV. Provider business mailing address

207 CLARA DR
TRENTON OH
45067-1562
US

V. Phone/Fax

Practice location:
  • Phone: 513-881-7189
  • Fax: 513-881-7188
Mailing address:
  • Phone: 513-881-7189
  • Fax: 513-881-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0500953
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: