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NPI Code Detail

MEDICARE: MS. JUDITH DEAN LISW-S

MEDICARE: MS. JUDITH DEAN LISW-S
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 0008305OH

General Provider Information

NPI Number : 1376631416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JUDITH DEAN LISW-S
Provider Business Mailing Address
First Line : 765 PIERCE DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43223-2425
Country : US
Telephone Number : 614-223-1650
Fax Number :
Provider Business Practice Location Address
First Line : 765 PIERCE DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43223-2425
Country : US
Telephone Number : 614-223-1650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 03/11/2016

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Directions to “ MS. JUDITH DEAN LISW-S” Practice Location

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