Healthcare Provider Details

I. General information

NPI: 1770061525
Provider Name (Legal Business Name): GRACE HUNTER HERTEL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE HUNTER HERTEL LISW-S, LICDC

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

IV. Provider business mailing address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

V. Phone/Fax

Practice location:
  • Phone: 614-344-6627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2102958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: