Provider Demographics
NPI:1174384648
Name:MCGIRR, KENNETH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:MCGIRR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 XENIA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1536
Mailing Address - Country:US
Mailing Address - Phone:937-407-5144
Mailing Address - Fax:
Practice Address - Street 1:765 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1960
Practice Address - Country:US
Practice Address - Phone:937-505-1877
Practice Address - Fax:800-480-7578
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHAPS.006269175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty