Healthcare Provider Details

I. General information

NPI: 1497231096
Provider Name (Legal Business Name): COURTNEY BECCA BIRKHIMER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 CHERRY VALLEY RD
NEWARK OH
43055-1323
US

IV. Provider business mailing address

5200 WHITE CHAPEL RD
HEATH OH
43056-9242
US

V. Phone/Fax

Practice location:
  • Phone: 740-755-4500
  • Fax:
Mailing address:
  • Phone: 614-571-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1802218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: