Healthcare Provider Details

I. General information

NPI: 1255862009
Provider Name (Legal Business Name): ASHLEY GRUHN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

IV. Provider business mailing address

38398 MISTY MEADOW TRL
NORTH RIDGEVILLE OH
44039-1165
US

V. Phone/Fax

Practice location:
  • Phone: 216-521-6511
  • Fax:
Mailing address:
  • Phone: 440-506-0256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: