Healthcare Provider Details

I. General information

NPI: 1033760442
Provider Name (Legal Business Name): JESSICA BYRD LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7667 SUMMERLIN BLVD
LIBERTY TOWNSHIP OH
45044-9377
US

IV. Provider business mailing address

8809B CINCINNATI DAYTON RD
WEST CHESTER OH
45069-3134
US

V. Phone/Fax

Practice location:
  • Phone: 513-759-8100
  • Fax: 513-759-8105
Mailing address:
  • Phone: 513-360-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2405934
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405934
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: