Provider Demographics
NPI:1154568830
Name:NIESE, MARIANNE (MSED, LPC)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:NIESE
Suffix:
Gender:F
Credentials:MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 WILLOWGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:315-521-0022
Mailing Address - Fax:
Practice Address - Street 1:2555 S DIXIE DR
Practice Address - Street 2:SUITE 260
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1539
Practice Address - Country:US
Practice Address - Phone:937-853-9061
Practice Address - Fax:937-853-9069
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0700024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health