Provider Demographics
NPI:1487703930
Name:KIRKPATRICK, RONALD D (MSW, LISW)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 LAKE CLUB DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3204
Mailing Address - Country:US
Mailing Address - Phone:614-322-1484
Mailing Address - Fax:614-322-9824
Practice Address - Street 1:2211 LAKE CLUB DR
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3204
Practice Address - Country:US
Practice Address - Phone:614-322-1484
Practice Address - Fax:614-322-9824
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI41031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKISW22814Medicare ID - Type Unspecified