Healthcare Provider Details

I. General information

NPI: 1679002166
Provider Name (Legal Business Name): WOOD COUNTY CHILDREN'S SERVICES ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 03/17/2018
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

PO BOX 738
BOWLING GREEN OH
43402-0738
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 TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELANIE VANDYNE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 419-352-7588