Healthcare Provider Details

I. General information

NPI: 1598181414
Provider Name (Legal Business Name): HEATHER TIETJEN MOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER TIETJEN MOONEY LISW-S

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 MADISON RD
CINCINNATI OH
45227-1491
US

IV. Provider business mailing address

6929 BENNETT RD
CINCINNATI OH
45230-3828
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-2800
  • Fax:
Mailing address:
  • Phone: 513-503-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI0008356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: