Provider Information for 1346488921
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MARLENE J FANNON LISW-S
Sex: Female
NPI: 1346488921
Last Updated: 2020-01-28
Certification Date: 2020-01-28
Certification Date: 2020-01-28
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1346488921 | ||||||||||||
| Enumeration Date | 2009-02-04 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 446 MORGAN ST CINCINNATI, OH 45206-2348 United States Phone: 513-834-7063 | Fax:513-873-1567 | ||||||||||||
| Primary Practice Address | 126 E 2ND ST CHILLICOTHE, OH 45601-2593 United States Phone: 513-834-7063 | Fax:513-873-1567 | ||||||||||||
| Secondary Practice Address(es) | 145 MORRIS RD | ||||||||||||
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