Healthcare Provider Details

I. General information

NPI: 1154068385
Provider Name (Legal Business Name): ALLYSON BALL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 C ST.
LIMA OH
45804-1832
US

IV. Provider business mailing address

401 E. MARKET ST.
CELINA OH
45822-1736
US

V. Phone/Fax

Practice location:
  • Phone: 419-584-5123
  • Fax: 567-890-7214
Mailing address:
  • Phone: 419-584-5123
  • Fax: 567-890-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2506846
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506846
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: