MEDICARE: RONALD D KIRKPATRICK MSW, 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
1	1041C0700X	Clinical Social Worker	I4103	OH

General Provider Information

NPI Number	:	1487703930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD D KIRKPATRICK MSW, LISW

Provider Business Mailing Address
First Line	:	2211 LAKE CLUB DR
Second Line	:	SUITE 220
City	:	COLUMBUS
State	:	OH
Zip	:	43232-3204
Country	:	US
Telephone Number	:	614-322-1484
Fax Number	:	614-322-9824

Provider Business Practice Location Address
First Line	:	2211 LAKE CLUB DR
Second Line	:	SUITE 220
City	:	COLUMBUS
State	:	OH
Zip	:	43232-3204
Country	:	US
Telephone Number	:	614-322-1484
Fax Number	:	614-322-9824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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