Healthcare Provider Details

I. General information

NPI: 1316448707
Provider Name (Legal Business Name): GINA V CLAWSON LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 KENTSHIRE DR STE A
DAYTON OH
45440-4254
US

IV. Provider business mailing address

5975 KENTSHIRE DR STE A
DAYTON OH
45440-4254
US

V. Phone/Fax

Practice location:
  • Phone: 937-210-9736
  • Fax:
Mailing address:
  • Phone: 937-210-9736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506560
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2101743-TRNE
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2207851
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: