=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942451505
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY J WITWER LISW-SUPV
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2008
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 IRVING AVE
-----------------------------------------------------
City | OAKWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45409-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-666-1029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 IRVING AVE
-----------------------------------------------------
City | OAKWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45409-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-666-1029
-----------------------------------------------------
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 | I.1801310-SUPV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------