Healthcare Provider Details

I. General information

NPI: 1477074714
Provider Name (Legal Business Name): DANIKA BRISSETT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 01/24/2023
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11590 CENTURY BLVD
CINCINNATI OH
45246-3326
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 513-771-7239
  • Fax: 513-771-3878
Mailing address:
  • Phone: 419-685-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1501095
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: