Provider Demographics
NPI:1659722858
Name:WANSTRATH, EMILY M (LISW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:WANSTRATH
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 1:4116 PAXTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1417
Mailing Address - Country:US
Mailing Address - Phone:513-442-9170
Mailing Address - Fax:
Practice Address - Street 1:8044 MONTGOMERY RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2919
Practice Address - Country:US
Practice Address - Phone:513-907-6238
Practice Address - Fax:844-965-9287
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI16002521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical