Healthcare Provider Details

I. General information

NPI: 1356820021
Provider Name (Legal Business Name): BETH ALYSON WERNKE MSW, LISW-S, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 04/10/2021
Certification Date: 04/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 OHIO PIKE STE 103N
CINCINNATI OH
45255-3372
US

IV. Provider business mailing address

3033 CRESTMOOR LN
CINCINNATI OH
45238-2005
US

V. Phone/Fax

Practice location:
  • Phone: 513-655-7140
  • Fax:
Mailing address:
  • Phone: 859-250-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.1901847
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number253844
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1600543
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: