Healthcare Provider Details

I. General information

NPI: 1578975785
Provider Name (Legal Business Name): ERIN KUTCHERA LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 DIXIE HWY
HAMILTON OH
45015-1653
US

IV. Provider business mailing address

3258 LILLWOOD LN
CINCINNATI OH
45251-2518
US

V. Phone/Fax

Practice location:
  • Phone: 513-737-3400
  • Fax:
Mailing address:
  • Phone: 513-289-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1000060
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: