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NPI Code Detail

MEDICARE: MR. DONALD JOSEPH HUPP JR. LISW

MEDICARE: MR. DONALD JOSEPH HUPP JR. LISW
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
1104100000XSocial WorkerI.0700263OH
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1568654242
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD JOSEPH HUPP JR. LISW
Provider Business Mailing Address
First Line : PO BOX 29
Second Line :
City : BOWLING GREEN
State : OH
Zip : 43402-0029
Country : US
Telephone Number : 419-352-5387
Fax Number : 419-725-0716
Provider Business Practice Location Address
First Line : 1010 N PROSPECT ST
Second Line :
City : BOWLING GREEN
State : OH
Zip : 43402-1335
Country : US
Telephone Number : 419-352-5387
Fax Number : 419-725-0716
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2007
Last Update Date : 09/13/2024

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