Healthcare Provider Details

I. General information

NPI: 1598207896
Provider Name (Legal Business Name): JODY ARNOLD LISWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 SUNSET AVE
SPRINGFIELD OH
45505-4310
US

IV. Provider business mailing address

1438 SUNSET AVE
SPRINGFIELD OH
45505-4310
US

V. Phone/Fax

Practice location:
  • Phone: 937-244-3649
  • Fax:
Mailing address:
  • Phone: 937-244-3649
  • Fax: 800-480-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS2005.203
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: