MEDICARE: CHELSEA K.M. BUNNELL 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.1600949	OH

General Provider Information

NPI Number	:	1336620624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA K.M. BUNNELL LSW

Provider Business Mailing Address
First Line	:	211 BIEDE AVE
Second Line	:
City	:	DEFIANCE
State	:	OH
Zip	:	43512-2497
Country	:	US
Telephone Number	:	419-782-8856
Fax Number	:	419-784-4506

Provider Business Practice Location Address
First Line	:	910 E MAPLE ST
Second Line	:
City	:	BRYAN
State	:	OH
Zip	:	43506-1841
Country	:	US
Telephone Number	:	419-636-2932
Fax Number	:	419-636-1982

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

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	08/24/2018

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Directions to “ CHELSEA K.M. BUNNELL LSW” Practice Location

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