Provider Demographics
NPI:1720699218
Name:SPILLMAN, BREANNA ARIEL (BSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:ARIEL
Last Name:SPILLMAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 GREENE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1534
Mailing Address - Country:US
Mailing Address - Phone:937-532-4502
Mailing Address - Fax:
Practice Address - Street 1:61 S STANFIELD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2992
Practice Address - Country:US
Practice Address - Phone:937-335-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator