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NPI Code Detail

MEDICARE: MRS. STEPHENE LORAN EVANS LISW, OCPC

MEDICARE: MRS. STEPHENE LORAN EVANS LISW, OCPC
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
1405300000XPrevention ProfessionalOCPC.161315OH
21041C0700XClinical Social WorkerI.1901792OH

General Provider Information

NPI Number : 1366824427
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHENE LORAN EVANS LISW, OCPC
Provider Business Mailing Address
First Line : 5666 CLOVER LN
Second Line :
City : WALBRIDGE
State : OH
Zip : 43465-9595
Country : US
Telephone Number : 734-644-3543
Fax Number :
Provider Business Practice Location Address
First Line : 1832 ADAMS ST
Second Line :
City : TOLEDO
State : OH
Zip : 43604-4428
Country : US
Telephone Number : 419-214-0606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2015
Last Update Date : 11/12/2019

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