Healthcare Provider Details

I. General information

NPI: 1699331314
Provider Name (Legal Business Name): ROBIN GWIN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2932 S 3 BS AND K RD
GALENA OH
43021-8545
US

IV. Provider business mailing address

67 WILSON DR
WORTHINGTON OH
43085-4023
US

V. Phone/Fax

Practice location:
  • Phone: 614-327-0668
  • Fax:
Mailing address:
  • Phone: 614-398-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1903536
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: