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General NPI Number Information
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NPI Number | 1851108104
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Entity Type | Organization
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Legal Business Name | NOTABLY GIFTED HEALTH AND WELLNESS
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 2800 E RIVER RD
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City | MORAINE
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State | OH
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Zip | 45439-1538
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Country | US
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Telephone | 937-985-3703
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 E RIVER RD
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City | MORAINE
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State | OH
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Zip | 45439-1538
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Country | US
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Telephone | 937-985-3703
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY KENNERSON
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Credential |
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Telephone | 937-985-3703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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