Provider Demographics
NPI:1558455345
Name:NELSON, JUNE KATHARINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:KATHARINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4230
Mailing Address - Country:US
Mailing Address - Phone:513-422-0699
Mailing Address - Fax:513-423-9872
Practice Address - Street 1:321 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4230
Practice Address - Country:US
Practice Address - Phone:513-422-0699
Practice Address - Fax:513-423-9872
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0001295101YM0800X
OHI-00034911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000001382OtherANTHEM PIN
OH000000001382OtherANTHEM PIN