Provider Demographics
NPI:1043804602
Name:DIJKSTRA, KEIGHT NEOMA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:KEIGHT
Middle Name:NEOMA
Last Name:DIJKSTRA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:YUELLIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-0396
Mailing Address - Country:US
Mailing Address - Phone:513-575-6227
Mailing Address - Fax:
Practice Address - Street 1:3012 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2269
Practice Address - Country:US
Practice Address - Phone:513-575-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.2207408104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator