Individual
ELISABETH NICOLE WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW, LSW
Contact information
Practice address
3095 KETTERING BLVD, MORAINE, OH 45439-1983
(937) 293-8300
Mailing address
3095 KETTERING BLVD, MORAINE, OH 45439-1983
(937) 293-8300
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.2208104
OH
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
09/14/2021
Last updated
08/10/2022
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