Provider Demographics
NPI:1952357824
Name:RUSH, TIFFANY ANNA (LISW)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ANNA
Last Name:RUSH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANNA
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:8622 WINTON ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231
Mailing Address - Country:US
Mailing Address - Phone:513-521-0500
Mailing Address - Fax:513-521-5010
Practice Address - Street 1:8622 WINTON ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231
Practice Address - Country:US
Practice Address - Phone:513-521-0500
Practice Address - Fax:513-521-5010
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-82761041C0700X
OHI-00082761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11807472OtherCAQH #
OH000000246008OtherANTHEM PIN
OH138585442890OtherHUMANA ID