Provider Demographics
NPI:1942255039
Name:SIGWARD, TIMOTHY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:SIGWARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 EXECUTIVE PARK DR STE 320
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-4015
Mailing Address - Country:US
Mailing Address - Phone:513-563-0488
Mailing Address - Fax:513-563-0428
Practice Address - Street 1:4015 EXECUTIVE PARK DR STE 320
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4015
Practice Address - Country:US
Practice Address - Phone:513-563-0488
Practice Address - Fax:513-563-0428
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5032103TC0700X
KY1265103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89000616Medicaid
OH0185973Medicaid
OH680015625OtherRR MEDICARE
OH680015625OtherRR MEDICARE
KY0736601Medicare PIN
OHCP17782Medicare PIN