Provider Demographics
NPI:1083073761
Name:ROSE-WILHELM, TIFFANI A (MSW, LISW)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:A
Last Name:ROSE-WILHELM
Suffix:
Gender:
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 S WALL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-1921
Mailing Address - Country:US
Mailing Address - Phone:614-233-1483
Mailing Address - Fax:614-972-6200
Practice Address - Street 1:855 S WALL ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-1921
Practice Address - Country:US
Practice Address - Phone:614-233-1483
Practice Address - Fax:614-972-6200
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17005351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0241526Medicaid