MEDICARE: GINA V CLAWSON 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
1	104100000X	Social Worker	S.2101743-TRNE	OH
2	106S00000X	Behavior Technician
3	104100000X	Social Worker	S.2207851	OH
4	1041C0700X	Clinical Social Worker	I.2506560	OH

General Provider Information

NPI Number	:	1316448707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA V CLAWSON LISW

Provider Business Mailing Address
First Line	:	5975 KENTSHIRE DR STE A
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-4254
Country	:	US
Telephone Number	:	937-210-9736
Fax Number	:

Provider Business Practice Location Address
First Line	:	5975 KENTSHIRE DR STE A
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-4254
Country	:	US
Telephone Number	:	937-210-9736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	05/11/2026

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