Provider Demographics
NPI:1396893434
Name:WILLIS, NANETTE (LSW)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:NANETTE
Other - Middle Name:MARIE
Other - Last Name:FELTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1518 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2140
Mailing Address - Country:US
Mailing Address - Phone:740-532-7855
Mailing Address - Fax:740-532-0557
Practice Address - Street 1:400E STATE STREET, STE D
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-529-1400
Practice Address - Fax:740-529-1400
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0019534104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09425Medicaid