Provider Demographics
NPI:1619421229
Name:KIRKBRIDE, LINDA
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:KIRKBRIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 SUGAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ROCK
Mailing Address - State:OH
Mailing Address - Zip Code:43720-9542
Mailing Address - Country:US
Mailing Address - Phone:740-674-4383
Mailing Address - Fax:
Practice Address - Street 1:2951 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1406
Practice Address - Country:US
Practice Address - Phone:740-454-5927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0700924101Y00000X
OH965611101YA0400X
OHRN187095163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse