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General NPI Number Information
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NPI Number | 1346488921
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Entity Type | Individual
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Provider Name | MARLENE J FANNON LISW-S
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Gender | Female
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 126 E 2ND ST
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-2593
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Country | US
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Telephone | 513-834-7063
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Fax | 513-873-1567
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Provider Business Mailing Address
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Address Line | 446 MORGAN ST
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City | CINCINNATI
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State | OH
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Zip | 45206-2348
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Country | US
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Telephone | 513-834-7063
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Fax | 513-873-1567
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1000181-SUPV
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.1000181-SUPV
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License Number State | OH
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