Individual provider Active NPI

Kelly Marie Heitkamp, LISW-S, TRCC

  • Clinical Social Worker
  • Liberty TWP, OH
National Provider Identifier
1336611524
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.1801384 Issued in OH
Practice address
6645 Princeton Glendale Rd
Liberty TWP, OH 45011-7547
Phone
(859) 322-2499
NPI assigned
Dec 28, 2018
Last updated
Jan 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I.1801384 OH Primary

Addresses

Primary practice location

6645 Princeton Glendale Rd
Liberty TWP, OH 45011-7547

Mailing address

3200 Burnet Ave
Cincinnati, OH 45229-3019

Other identifiers 1

IdentifierTypeStateIssuer
0387182MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191018002037 OH Practitioner - Clinical Social Worker 4183955321 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

6645 Princeton Glendale Rd
Liberty TWP, OH 45011-7547
Phone (513) 584-8865

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I.1801384OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Craig and Frances Lindner Center of Hope CurrentSince Nov 19, 2023 Accepting new patients
Lindner Center of Hope Professional Associates Clinical CurrentSince Nov 19, 2023 Accepting new patients
Neuropsych Center of Greater Cincinnati LLC CurrentSince Dec 8, 2024 Accepting new patients
Mindfully, LLC Clinical CurrentSince Aug 7, 2019 Accepting new patients
Sondermind Provider Network LLC Clinical CurrentSince May 11, 2023 Accepting new patients
Neuropsych Center of Greater Cincinnati LLC Clinical CurrentSince Aug 1, 2021 Accepting new patients
University of Cincinnati Physicians Company, LLC CurrentSince Mar 1, 2025 Accepting new patients
Mindfully, LLC CurrentSince Aug 7, 2019 Accepting new patients
Neuropsych Center of Greater Cincinnati Past Accepting new patients

Locations

2123 Auburn Ave
#A28
Cincinnati, OH 45219
Phone (513) 585-0523

3188 Bellevue Ave
Cincinnati, OH 45219
Phone (513) 558-5281

3200 Burnet Ave
Cincinnati, OH 45229
Phone (513) 585-2201

4015 Executive Park Dr
Ste 320
Cincinnati, OH 45241
Phone (513) 563-0488

20 S 3rd St
Ste 210
Columbus, OH 43215
Phone (614) 208-4973

1251 Nilles Rd
Ste 5
Fairfield, OH 45014
Phone (732) 993-4599

6645 Princeton Glendale Rd
Liberty Twp, OH 45011
Phone (513) 584-8865

4075 Old Western Row Rd
Mason, OH 45040
Phone (513) 536-0232

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1336611524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6645 PRINCETON GLENDALE RD",
            "city": "LIBERTY TWP",
            "state": "OH",
            "postal_code": "450117547",
            "telephone_number": "859-322-2499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEITKAMP",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LISW-S, TRCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-28",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1801384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0387182",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty TWP, OH

Sources for this page

Verify at the official NPI Registry.