Kennedy Michele Clark | Cincinnati, OH • PECOS Search

Kennedy Michele Clark

Social Worker

Behavioral Health & Social Service Providers

4633 Aicholtz Rd, Cincinnati, OH 45244-1447

(513) 752-1555 (513) 319-1676

PECOS Enrollment

Based on the most recent information from CMS, provider Kennedy Michele Clark does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1376168211
Provider Type
Individual
Full Name
Clark, Kennedy Michele
Gender
Female

Sole Proprietor
No
Enumeration Date
6/16/2020
Last Updated
6/16/2020

Contact Information

Practice Location

4633 Aicholtz Rd, Cincinnati, OH 45244-1447

Unlisted Fax

Mailing Location

4629 Aicholtz Rd, Cincinnati, OH 45244-1551

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 104100000X Primary	Description Social Worker Behavioral Health & Social Service Providers	License S.2004802 Ohio