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NPI Code Detail

MEDICARE: JEAN MARIE TIDD LISW

MEDICARE: JEAN MARIE TIDD 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 WorkerI-8292OH

General Provider Information

NPI Number : 1295764322
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN MARIE TIDD LISW
Provider Business Mailing Address
First Line : 548 TIBET RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43202-2249
Country : US
Telephone Number : 614-263-5594
Fax Number :
Provider Business Practice Location Address
First Line : 40 SPRUCE ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-2204
Country : US
Telephone Number : 614-227-6865
Fax Number : 614-227-6873
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2006
Last Update Date : 07/08/2007

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Directions to “ JEAN MARIE TIDD LISW” Practice Location

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