MEDICARE: LAUREN ASHLEY APPLEGATE 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.1430095	OH

General Provider Information

NPI Number	:	1578109294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ASHLEY APPLEGATE LSW

Provider Business Mailing Address
First Line	:	2709 SUNRISE AVE
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-2549
Country	:	US
Telephone Number	:	740-250-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	23030 STATE ROUTE 73
Second Line	:
City	:	WEST PORTSMOUTH
State	:	OH
Zip	:	45663-8861
Country	:	US
Telephone Number	:	408-581-0637
Fax Number	:	740-858-9140

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

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	01/07/2021

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