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General NPI Number Information
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NPI Number | 1548792013
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Entity Type | Individual
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Provider Name | REBECCA KINKADE
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Gender | Female
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 255 W MAIN ST
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City | SAINT CLAIRSVILLE
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State | OH
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Zip | 43950-1040
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Country | US
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Telephone | 740-795-9447
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Fax | 740-695-8895
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Provider Business Mailing Address
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Address Line | 3201 BELMONT STREET SUITE 516
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City | BELLAIRE
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State | OH
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Zip | 43906
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Country | US
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Telephone | 740-676-5741
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Fax | 740-676-8951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I1200410-SUPV
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License Number State | OH
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