Provider Demographics
NPI:1942661764
Name:ECKENHOFF JOHNSON, KATE
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:ECKENHOFF JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:ECKENHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 WALL ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2781
Mailing Address - Country:US
Mailing Address - Phone:513-834-7063
Mailing Address - Fax:513-429-4939
Practice Address - Street 1:2300 WALL ST
Practice Address - Street 2:SUITE F
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212
Practice Address - Country:US
Practice Address - Phone:513-834-7063
Practice Address - Fax:513-429-4939
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161545171M00000X
OHCDCA.162903101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271913Medicaid