Provider Demographics
NPI:1740050707
Name:EDISON, TIERRA J (BSW)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:J
Last Name:EDISON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NA
Mailing Address - Street 1:129 ROLFE DR
Mailing Address - Street 2:
Mailing Address - City:SABINA
Mailing Address - State:OH
Mailing Address - Zip Code:45169-1239
Mailing Address - Country:US
Mailing Address - Phone:513-377-1121
Mailing Address - Fax:
Practice Address - Street 1:129 ROLFE DR
Practice Address - Street 2:
Practice Address - City:SABINA
Practice Address - State:OH
Practice Address - Zip Code:45169-1239
Practice Address - Country:US
Practice Address - Phone:513-377-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker