Healthcare Provider Details

I. General information

NPI: 1467820134
Provider Name (Legal Business Name): DANA M HURD LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W LOVELAND AVE SUITE 2A
LOVELAND OH
45140-2359
US

IV. Provider business mailing address

600 W LOVELAND AVE SUITE 2A
LOVELAND OH
45140-2359
US

V. Phone/Fax

Practice location:
  • Phone: 513-683-4673
  • Fax:
Mailing address:
  • Phone: 513-683-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1302211
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: