Healthcare Provider Details

I. General information

NPI: 1376907873
Provider Name (Legal Business Name): SHARON WISE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON RITTER-WISE LISW

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PLEASANT AVE
HAMILTON OH
45015-1133
US

IV. Provider business mailing address

2100 PLEASANT AVE
HAMILTON OH
45015-1133
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-1562
  • Fax:
Mailing address:
  • Phone: 513-868-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberI00009143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: