Provider Demographics
NPI:1164876199
Name:STANTZ, DASHIA (LISW)
Entity Type:Individual
Prefix:
First Name:DASHIA
Middle Name:
Last Name:STANTZ
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 1:2850 WINSLOW AVE.
Mailing Address - Street 2:ML9700
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206
Mailing Address - Country:US
Mailing Address - Phone:513-636-0025
Mailing Address - Fax:513-636-0661
Practice Address - Street 1:2850 WINSLOW AVE.
Practice Address - Street 2:ML9700
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206
Practice Address - Country:US
Practice Address - Phone:513-636-0225
Practice Address - Fax:513-636-0661
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1700107-SUPV104100000X
OHI.17001071041C0700X
OHS1450441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
724575OtherWORKERS' COMPENSATION EMPLOYER RISK NUMBER
OH2846595Medicaid