MEDICARE: RAVEN MARIE VANHOUTEN LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	S.2614048	OH

General Provider Information

NPI Number	:	1174217673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN MARIE VANHOUTEN LSW

Provider Business Mailing Address
First Line	:	PO BOX 877
Second Line	:
City	:	GALION
State	:	OH
Zip	:	44833-0877
Country	:	US
Telephone Number	:	419-566-2891
Fax Number	:	567-393-9480

Provider Business Practice Location Address
First Line	:	7807 STATE ROUTE 309 LOT 1
Second Line	:
City	:	GALION
State	:	OH
Zip	:	44833-9752
Country	:	US
Telephone Number	:	419-566-2891
Fax Number	:	567-393-9480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/15/2026

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Directions to “ RAVEN MARIE VANHOUTEN LSW” Practice Location

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