Provider Demographics
NPI:1669704680
Name:ICKES, KELLY ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:ICKES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9292 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4637
Mailing Address - Country:US
Mailing Address - Phone:513-515-7615
Mailing Address - Fax:513-268-2052
Practice Address - Street 1:9122 MONTGOMERY RD STE 214
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7761
Practice Address - Country:US
Practice Address - Phone:513-268-8575
Practice Address - Fax:513-268-2052
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH6655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical