Provider Demographics
NPI:1487029641
Name:BLUNT-WILLIAMS, KESHA (LSW, CA-CYFSW)
Entity Type:Individual
Prefix:DR
First Name:KESHA
Middle Name:
Last Name:BLUNT-WILLIAMS
Suffix:
Gender:F
Credentials:LSW, CA-CYFSW
Other - Prefix:DR
Other - First Name:KESHA
Other - Middle Name:
Other - Last Name:BLUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, CA-CYFSW
Mailing Address - Street 1:4724 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45217-1254
Mailing Address - Country:US
Mailing Address - Phone:513-349-1440
Mailing Address - Fax:513-482-7993
Practice Address - Street 1:4724 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217-1254
Practice Address - Country:US
Practice Address - Phone:513-349-1440
Practice Address - Fax:513-482-7993
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0027922106H00000X, 172V00000X
OHS. 0027922171M00000X, 171W00000X, 174H00000X, 104100000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator