Healthcare Provider Details

I. General information

NPI: 1407375090
Provider Name (Legal Business Name): KEYANA RENEE ACHEAMPONG LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 MONROE ST STE 2
SYLVANIA OH
43560-2263
US

IV. Provider business mailing address

4600 MCAULEY PL STE 600
BLUE ASH OH
45242-4778
US

V. Phone/Fax

Practice location:
  • Phone: 419-343-7737
  • Fax:
Mailing address:
  • Phone: 419-251-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1803013
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: