Provider Demographics
NPI:1356028567
Name:NIESEN, GWENDOLYN MARIE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:MARIE
Last Name:NIESEN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:MISS
Other - First Name:GWENDOLYN
Other - Middle Name:MARIE
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1080 NIMITZVIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4300
Mailing Address - Country:US
Mailing Address - Phone:513-233-0020
Mailing Address - Fax:
Practice Address - Street 1:1080 NIMITZVIEW DR STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4300
Practice Address - Country:US
Practice Address - Phone:513-233-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
S.15013321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical