Provider Demographics
NPI:1942451505
Name:WITWER, JEFFREY J (LISW-SUPV)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:WITWER
Suffix:
Gender:M
Credentials:LISW-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2422
Mailing Address - Country:US
Mailing Address - Phone:513-666-1029
Mailing Address - Fax:
Practice Address - Street 1:404 IRVING AVE
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45409-2422
Practice Address - Country:US
Practice Address - Phone:513-666-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1801310-SUPV1041C0700X
OHI.18013101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical