Healthcare Provider Details

I. General information

NPI: 1689189326
Provider Name (Legal Business Name): JESSICA NICOLE SPARTIN LIWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 S ERIE HWY
HAMILTON OH
45011-4118
US

IV. Provider business mailing address

1750 S ERIE HWY
HAMILTON OH
45011-4118
US

V. Phone/Fax

Practice location:
  • Phone: 513-870-9444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700484
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: