Provider Demographics
NPI:1225552110
Name:PLESKA, CORRINE ASHLEE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:ASHLEE
Last Name:PLESKA
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 EDALBERT DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7604
Mailing Address - Country:US
Mailing Address - Phone:513-262-0670
Mailing Address - Fax:
Practice Address - Street 1:212 N BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1704
Practice Address - Country:US
Practice Address - Phone:937-336-5094
Practice Address - Fax:574-406-7311
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.17002271041C0700X
OHI.19017911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0423793Medicaid