Provider Demographics
NPI:1992296651
Name:REESE, KRISTINE LAISE (CDCA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LAISE
Last Name:REESE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8977 COLUMBIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-1100
Mailing Address - Country:US
Mailing Address - Phone:513-409-3635
Mailing Address - Fax:513-402-0408
Practice Address - Street 1:8977 COLUMBIA RD STE A
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-1100
Practice Address - Country:US
Practice Address - Phone:513-409-3635
Practice Address - Fax:513-402-0408
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140412101YA0400X
OHW.2300368104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid