Healthcare Provider Details

I. General information

NPI: 1629844907
Provider Name (Legal Business Name): PAULA EGGEBRECHT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 FAIRGROVE AVE
HAMILTON OH
45011-1966
US

IV. Provider business mailing address

510 HOLLAND DR
TRENTON OH
45067-9704
US

V. Phone/Fax

Practice location:
  • Phone: 513-889-5880
  • Fax:
Mailing address:
  • Phone: 513-403-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2005386
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: