MEDICARE: DIANA PEARSON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	S0015228	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	981136	OH
3	104100000X	Social Worker
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1548714025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA PEARSON

Provider Business Mailing Address
First Line	:	4819 WILLOW RIDGE DR
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-0417
Country	:	US
Telephone Number	:	513-894-6509
Fax Number	:	513-751-1545

Provider Business Practice Location Address
First Line	:	4819 WILLOW RIDGE DR
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-0417
Country	:	US
Telephone Number	:	513-894-6509
Fax Number	:	513-751-1545

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

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	08/20/2025

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Directions to “ DIANA PEARSON ” Practice Location

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