MEDICARE: DONNA R WAFORD LICDC, LSW

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	S0022964	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	923364	OH

General Provider Information

NPI Number	:	1710615117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA R WAFORD LICDC, LSW

Provider Business Mailing Address
First Line	:	1612 CHASE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-2204
Country	:	US
Telephone Number	:	513-541-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W 66TH ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45216-1949
Country	:	US
Telephone Number	:	513-461-2158
Fax Number	:

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	08/12/2022

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Directions to “ DONNA R WAFORD LICDC, LSW” Practice Location

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