Healthcare Provider Details

I. General information

NPI: 1821912577
Provider Name (Legal Business Name): DANIELLE KIRK ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 S US HIGHWAY 68
URBANA OH
43078-2584
US

IV. Provider business mailing address

2200 S US HIGHWAY 68
URBANA OH
43078-9470
US

V. Phone/Fax

Practice location:
  • Phone: 937-653-1453
  • Fax:
Mailing address:
  • Phone: 937-484-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01847
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: