Provider Demographics
NPI:1124053046
Name:DWINNELL, BETHANY TROTH (LISW)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:TROTH
Last Name:DWINNELL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1148
Mailing Address - Country:US
Mailing Address - Phone:614-529-9966
Mailing Address - Fax:614-761-1962
Practice Address - Street 1:139 WATERFORD DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1148
Practice Address - Country:US
Practice Address - Phone:614-529-9966
Practice Address - Fax:614-761-1962
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-81971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW20741Medicare ID - Type Unspecified