Healthcare Provider Details

I. General information

NPI: 1063742773
Provider Name (Legal Business Name): HEATHER ANN CONNOR LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 YANKEE RD
LIBERTY TOWNSHIP OH
45044-3500
US

IV. Provider business mailing address

7777 YANKEE RD. ML 16066
LIBERTY TOWNSHIP OH
45044-3500
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-9600
  • Fax: 513-636-2300
Mailing address:
  • Phone: 513-803-9600
  • Fax: 513-636-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI 1200343
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1200343-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: