Healthcare Provider Details

I. General information

NPI: 1124015524
Provider Name (Legal Business Name): WOOD COUNTY CHILDREN'S SERVICES ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 KLOTZ RD
BOWLING GREEN OH
43402-4820
US

IV. Provider business mailing address

1045 KLOTZ RD P.O. BOX 738
BOWLING GREEN OH
43402-4820
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-7588
  • Fax: 419-354-4977
Mailing address:
  • Phone: 419-352-7588
  • Fax: 419-354-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MELANIE A KNEESSI
Title or Position: COORDINATOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 419-352-7588