Provider Demographics
NPI:1508561762
Name:SIMPSON, LAKEENA (STNA)
Entity Type:Individual
Prefix:
First Name:LAKEENA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 MARSHALL AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225-2249
Mailing Address - Country:US
Mailing Address - Phone:513-926-9197
Mailing Address - Fax:
Practice Address - Street 1:1040 MARSHALL AVE APT 3
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-2249
Practice Address - Country:US
Practice Address - Phone:513-926-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401352850212405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty