Healthcare Provider Details

I. General information

NPI: 1578913331
Provider Name (Legal Business Name): TODJA TI-ANNA STIRTMIRE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 OLD TROY PIKE
HUBER HEIGHTS OH
45424-1054
US

IV. Provider business mailing address

PO BOX 933421
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-237-4945
  • Fax: 937-237-4925
Mailing address:
  • Phone: 937-641-5072
  • Fax: 937-641-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1502329
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: