Provider Demographics
NPI:1861699191
Name:WESSELS, JUDITH A (LISW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:WESSELS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2697 CLYDE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5911
Mailing Address - Country:US
Mailing Address - Phone:513-738-0201
Mailing Address - Fax:
Practice Address - Street 1:10921 REED HARTMAN HWY
Practice Address - Street 2:SUITE 133
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-2830
Practice Address - Country:US
Practice Address - Phone:513-984-9838
Practice Address - Fax:513-984-8075
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0007410104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker