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NPI Code Detail

MEDICARE: CRYSTA FLETCHER LISW

MEDICARE: CRYSTA FLETCHER LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI1000115OH

General Provider Information

NPI Number : 1003205121
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTA FLETCHER LISW
Provider Business Mailing Address
First Line : 4760 MADISON RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45227-1426
Country : US
Telephone Number : 513-861-0035
Fax Number :
Provider Business Practice Location Address
First Line : 3284 NORTH BEND RD
Second Line : SUITE 314
City : CINCINNATI
State : OH
Zip : 45239-7688
Country : US
Telephone Number : 513-481-2432
Fax Number : 513-662-2432
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2015
Last Update Date : 12/20/2017

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Directions to “ CRYSTA FLETCHER LISW” Practice Location

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