Provider Demographics
NPI:1376015933
Name:KNALEY, TINA RENEE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:RENEE
Last Name:KNALEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8487 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-1300
Mailing Address - Country:US
Mailing Address - Phone:513-766-3351
Mailing Address - Fax:513-766-3358
Practice Address - Street 1:8487 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-1300
Practice Address - Country:US
Practice Address - Phone:513-766-3351
Practice Address - Fax:513-766-3358
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0031939104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.0031939Medicaid