Provider Demographics
NPI:1457746588
Name:MICHELLE RISSER LISW, INC
Entity Type:Organization
Organization Name:MICHELLE RISSER LISW, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-582-1734
Mailing Address - Street 1:2183 OTTER LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9067
Mailing Address - Country:US
Mailing Address - Phone:614-582-1734
Mailing Address - Fax:
Practice Address - Street 1:37 E WILSON BRIDGE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2354
Practice Address - Country:US
Practice Address - Phone:614-582-1734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07001281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty