Provider Demographics
NPI:1396107173
Name:EIDSON, TAMMY (LISW, MSW, LSW)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:EIDSON
Suffix:
Gender:F
Credentials:LISW, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1578
Mailing Address - Country:US
Mailing Address - Phone:740-532-4858
Mailing Address - Fax:740-532-4859
Practice Address - Street 1:55 TOWNSHIP ROAD 508 E
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7276
Practice Address - Country:US
Practice Address - Phone:740-377-2712
Practice Address - Fax:740-377-2588
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1201580104100000X
OHI.1700020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI1700020OtherOHIO LICENSE
OHI1700020OtherOHIO LICENSE