Provider Demographics
NPI:1083702880
Name:RASCHKE, KELLEY (LISW)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:RASCHKE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2009
Mailing Address - Country:US
Mailing Address - Phone:513-922-1660
Mailing Address - Fax:513-922-6230
Practice Address - Street 1:3557 SPRINGDALE RD
Practice Address - Street 2:BLDG. C
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1314
Practice Address - Country:US
Practice Address - Phone:513-922-1660
Practice Address - Fax:513-922-6230
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCI9282111Medicare ID - Type Unspecified