Provider Demographics
NPI:1407519382
Name:OSHEL, KENEDIE BROOKE (LMSW)
Entity Type:Individual
Prefix:
First Name:KENEDIE
Middle Name:BROOKE
Last Name:OSHEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CONSTANTIA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-4105
Mailing Address - Country:US
Mailing Address - Phone:304-881-7812
Mailing Address - Fax:
Practice Address - Street 1:113 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1843
Practice Address - Country:US
Practice Address - Phone:937-247-9015
Practice Address - Fax:937-247-9009
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12406104100000X
OHS.2208192104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker