Kelly Ann Ickes, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6655 Issued in OH

Practice address

9122 Montgomery Rd Ste 214
Cincinnati, OH 45242-7761

Phone

(513) 268-8575

Fax

(513) 268-2052

NPI assigned

Feb 1, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Vital Minds, LLC

  • Clinical Psychologist
  • Cincinnati, OH
  • NPI 1902687932
  NPD Authorized official
• Professional Psychiatric Services, LLC

  • Psychiatry Physician
  • West Chester, OH
  • NPI 1538115092
  NPD (past)

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

{
    "created_epoch": "1264982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1669704680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9292 STEEPLECHASE DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452424637",
            "telephone_number": "513-515-7615",
            "fax_number": "513-268-2052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9122 MONTGOMERY RD STE 214",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452427761",
            "telephone_number": "513-268-8575",
            "fax_number": "513-268-2052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICKES",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-01",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "6655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ibg Enterprises, Inc.
• Arwa Khalid Ibrahem Ibrahem
• Naziha Walid Ibrahim
• Shaimaa Ibrahim
• Kenzo Ichimura, MD
• Morgan Iddings, APRN
• Danielle Iddins, NBC-HWC
• Ideal Home Care
• Ideal Home Care
• Ideal Home Care

• Clinical Psychologist in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.