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Individual
TAMMY EIDSON
Active
Individual
TAMMY EIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW, MSW, LSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I.1700020
OH
104100000X
Social Worker
S1201580
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I1700020
OHIO LICENSE
OH
Enumeration date
03/22/2016
Last updated
03/17/2017
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