Healthcare Provider Details

I. General information

NPI: 1386213296
Provider Name (Legal Business Name): MICHAELA SLATER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHAELA CALHOUN

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 C CT
ASHTABULA OH
44004-4577
US

IV. Provider business mailing address

2801 C CT
ASHTABULA OH
44004-4577
US

V. Phone/Fax

Practice location:
  • Phone: 440-998-4210
  • Fax: 440-998-6489
Mailing address:
  • Phone: 440-998-4210
  • Fax: 440-998-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2410958
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608857
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: