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NPI Code Detail

MEDICARE: MS. KELLY MARIE HEITKAMP LISW

MEDICARE: MS. KELLY MARIE HEITKAMP LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.1801384OH

General Provider Information

NPI Number : 1336611524
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY MARIE HEITKAMP LISW
Provider Business Mailing Address
First Line : 1900 FAIRGROVE AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45011-1966
Country : US
Telephone Number : 513-785-4895
Fax Number : 513-785-4896
Provider Business Practice Location Address
First Line : 1900 FAIRGROVE AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45011-1966
Country : US
Telephone Number : 513-785-4895
Fax Number : 513-785-4896
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2018
Last Update Date : 10/20/2020

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Directions to “ MS. KELLY MARIE HEITKAMP LISW” Practice Location

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