Provider Demographics
NPI:1497084172
Name:TILLINGHAST, JANE M (LISW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:TILLINGHAST
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 1:1080 NIMITZVIEW DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4314
Mailing Address - Country:US
Mailing Address - Phone:513-688-7555
Mailing Address - Fax:513-688-5432
Practice Address - Street 1:1080 NIMITZVIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4314
Practice Address - Country:US
Practice Address - Phone:513-688-7555
Practice Address - Fax:513-688-5432
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI09001261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical