Healthcare Provider Details

I. General information

NPI: 1891214086
Provider Name (Legal Business Name): HEATHER GALBRAITH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST
ALVORDTON OH
43501-9763
US

IV. Provider business mailing address

885 COMMERCE DR
PERRYSBURG OH
43551-5267
US

V. Phone/Fax

Practice location:
  • Phone: 419-924-2029
  • Fax:
Mailing address:
  • Phone: 419-330-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1800894
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: