Provider Demographics
NPI:1275121048
Name:WILKEN DEVELOPMENTAL AND BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:WILKEN DEVELOPMENTAL AND BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PRENTISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-389-4504
Mailing Address - Street 1:8075 READING RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-1415
Mailing Address - Country:US
Mailing Address - Phone:513-975-8470
Mailing Address - Fax:
Practice Address - Street 1:8075 READING RD STE 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-1415
Practice Address - Country:US
Practice Address - Phone:513-975-8470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)