1902181100 NPI number — DR. SUSAN LOUISE KENFORD PH.D.

Table of content: DR. SUSAN LOUISE KENFORD PH.D. (NPI 1902181100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902181100 NPI number — DR. SUSAN LOUISE KENFORD PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENFORD
Provider First Name:
SUSAN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902181100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 VICTORY PKWY
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHOLOGY
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45207-6411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-559-9871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  5334 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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