Healthcare Provider Details

I. General information

NPI: 1851517015
Provider Name (Legal Business Name): ANNA JANETTE CONATY LISW, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA JANETTE CONATY LISW, ATR

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4464 S DIXIE HWY
MIDDLETOWN OH
45005-5464
US

IV. Provider business mailing address

4464 S DIXIE HWY
MIDDLETOWN OH
45005-5464
US

V. Phone/Fax

Practice location:
  • Phone: 513-649-8008
  • Fax: 513-649-8004
Mailing address:
  • Phone: 513-649-8008
  • Fax: 513-649-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.1451068
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1451068
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number#07-031
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: