=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841513876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA LOUISE GRIMM LISW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2010
-----------------------------------------------------
Last Update Date | 03/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 VINE ST WOMEN'S HEALTH DEPT
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45220-2213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-247-4280
-----------------------------------------------------
Fax | 513-247-4648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11500 NORTHLAKE DR SUITE 200
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45249-1650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-247-4280
-----------------------------------------------------
Fax | 513-247-4648
-----------------------------------------------------
=====================================================
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 | I.0800315
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------