=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477150027
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEREDITH HAYDEN LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2020
-----------------------------------------------------
Last Update Date | 10/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7162 READING RD STE 300
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45237-3899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-961-5900
-----------------------------------------------------
Fax | 513-961-5903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8721 TIBURON DR
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45249-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-417-5091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | S1802989
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------