Provider Demographics
NPI:1033363544
Name:KIRKSEY, KENNETH TODD (LISW-S, CEAP)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:TODD
Last Name:KIRKSEY
Suffix:
Gender:M
Credentials:LISW-S, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-6600
Mailing Address - Country:US
Mailing Address - Phone:614-582-1835
Mailing Address - Fax:614-837-0112
Practice Address - Street 1:60 W COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1256
Practice Address - Country:US
Practice Address - Phone:614-837-0063
Practice Address - Fax:614-837-0112
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 0008323SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical