MEDICARE: DR. SUSAN LOUISE KENFORD PH.D.

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	103TC0700X	Clinical Psychologist	5334	OH

General Provider Information

NPI Number	:	1902181100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN LOUISE KENFORD PH.D.

Provider Business Mailing Address
First Line	:	3961 WINDING WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-1960
Country	:	US
Telephone Number	:	513-745-3451
Fax Number	:	513-745-4380

Provider Business Practice Location Address
First Line	:	3800 VICTORY PKWY
Second Line	:	DEPARTMENT OF PSYCHOLOGY
City	:	CINCINNATI
State	:	OH
Zip	:	45207-6411
Country	:	US
Telephone Number	:	513-559-9871
Fax Number	:

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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