MEDICARE: CHERYL STAUFFER MSW 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	S1100689	OH
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1750781324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL STAUFFER MSW LSW

Provider Business Mailing Address
First Line	:	PO BOX 102
Second Line	:
City	:	WILLSHIRE
State	:	OH
Zip	:	45898-0102
Country	:	US
Telephone Number	:	419-513-0428
Fax Number	:	419-495-2320

Provider Business Practice Location Address
First Line	:	813 N FRANKLIN ST
Second Line	:
City	:	VAN WERT
State	:	OH
Zip	:	45891-1303
Country	:	US
Telephone Number	:	419-513-0428
Fax Number	:	419-238-3565

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

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	03/20/2015

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