Healthcare Provider Details

I. General information

NPI: 1578015764
Provider Name (Legal Business Name): EVELYN HEFLIN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 BURNS ST
CINCINNATI OH
45204-1942
US

IV. Provider business mailing address

605 BURNS ST
CINCINNATI OH
45204-1942
US

V. Phone/Fax

Practice location:
  • Phone: 513-216-0116
  • Fax:
Mailing address:
  • Phone: 513-216-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1600298
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: