Healthcare Provider Details

I. General information

NPI: 1548613326
Provider Name (Legal Business Name): MEGAN ELIZABETH LIZAK JONES LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S MARTIN LUTHER KING JR BLVD
HAMILTON OH
45011-3216
US

IV. Provider business mailing address

230 LUDLOW ST
HAMILTON OH
45011-2903
US

V. Phone/Fax

Practice location:
  • Phone: 513-887-8500
  • Fax: 513-737-8196
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1901774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: