Provider Demographics
NPI:1376907873
Name:WISE, SHARON (LISW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:RITTER-WISE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:2100 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1133
Mailing Address - Country:US
Mailing Address - Phone:513-868-1562
Mailing Address - Fax:
Practice Address - Street 1:2100 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1133
Practice Address - Country:US
Practice Address - Phone:513-868-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI000091431041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool