Provider Demographics
NPI:1427567510
Name:DEHOFF, NICHOLAS WAYNE
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:WAYNE
Last Name:DEHOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 CHEVIOT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-5907
Mailing Address - Country:US
Mailing Address - Phone:513-741-2528
Mailing Address - Fax:
Practice Address - Street 1:8801 CHEVIOT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-5907
Practice Address - Country:US
Practice Address - Phone:513-741-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21438744103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool