Healthcare Provider Details

I. General information

NPI: 1205428810
Provider Name (Legal Business Name): ELLEN TABELING LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MADISON RD
WALNUT HILLS OH
45206-1706
US

IV. Provider business mailing address

1501 MADISON RD
WALNUT HILLS OH
45206-1706
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-5200
  • Fax:
Mailing address:
  • Phone: 513-354-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2101724
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2507163
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.2101724
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: