Provider Demographics
NPI:1851964167
Name:HATCHER, KIP R (MA)
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:R
Last Name:HATCHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36040
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-0040
Mailing Address - Country:US
Mailing Address - Phone:513-910-6935
Mailing Address - Fax:
Practice Address - Street 1:6523 CRESTRIDGE CIR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-1051
Practice Address - Country:US
Practice Address - Phone:513-910-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY114306103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist