Jill Marie Mysonhimer, LISW-SUPV

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I-1101601-SUPV Issued in OH

Practice address

975 Kingsview Dr
BLDG a
Lebanon, OH 45036-9562

Phone

(513) 228-7800

Fax

(513) 228-7846

NPI assigned

Oct 12, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jill Marie McIntosh Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446681600000",
    "number": "1568797439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 COOK RD",
            "address_2": "SUITE 400",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450369600",
            "telephone_number": "513-228-7800",
            "fax_number": "513-695-2952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 KINGSVIEW DR",
            "address_2": "BLDG A",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450369562",
            "telephone_number": "513-228-7800",
            "fax_number": "513-228-7846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYSONHIMER",
        "first_name": "JILL",
        "middle_name": "MARIE",
        "credential": "LISW-SUPV",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-12",
        "last_updated": "2015-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-1101601-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "MCINTOSH",
            "middle_name": "MARIE",
            "credential": "LISW-SUPV",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Lebanon, OH
• Providers in Lebanon, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.