Provider Demographics
NPI:1093204596
Name:ETTER, TAMI DAWN (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:DAWN
Last Name:ETTER
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:D
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:280 MONTGOMERY LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-5018
Mailing Address - Country:US
Mailing Address - Phone:937-284-2051
Mailing Address - Fax:
Practice Address - Street 1:1879 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8602
Practice Address - Country:US
Practice Address - Phone:513-695-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1701674104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker