Provider Demographics
NPI:1083201586
Name:DWIRE, TESSA (MASW, LSW)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:DWIRE
Suffix:
Gender:F
Credentials:MASW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 ELIN CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1150
Mailing Address - Country:US
Mailing Address - Phone:630-777-7842
Mailing Address - Fax:
Practice Address - Street 1:10921 REED HARTMAN HWY STE 133
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2851
Practice Address - Country:US
Practice Address - Phone:513-984-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2303057-TRNE104100000X
251S00000X
OHS.2410635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251S00000XAgenciesCommunity/Behavioral Health