Provider Demographics
NPI:1558354167
Name:EASON, ANNE WIER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:WIER
Last Name:EASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 CROCUS LN
Mailing Address - Street 2:
Mailing Address - City:TAYLOR MILL
Mailing Address - State:KY
Mailing Address - Zip Code:41015-4125
Mailing Address - Country:US
Mailing Address - Phone:859-491-6885
Mailing Address - Fax:
Practice Address - Street 1:519 LICKING PIKE
Practice Address - Street 2:THERAPEUTIC COLLABORATIVE
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41071-2941
Practice Address - Country:US
Practice Address - Phone:859-572-0400
Practice Address - Fax:859-442-3363
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY9961041C0700X
OHI00080201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS21566Medicare UPIN