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NPI Code Detail

MEDICARE: BETH BRAUCKSIECK BSW, LSW

MEDICARE: BETH BRAUCKSIECK BSW, 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
11041C0700XClinical Social WorkerS.1000818OH

General Provider Information

NPI Number : 1659737211
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH BRAUCKSIECK BSW, LSW
Provider Business Mailing Address
First Line : 1425 STARR AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43605-2456
Country : US
Telephone Number : 419-693-0631
Fax Number :
Provider Business Practice Location Address
First Line : 1425 STARR AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43605-2456
Country : US
Telephone Number : 419-693-0631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2016
Last Update Date : 05/06/2026

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