Healthcare Provider Details

I. General information

NPI: 1851254619
Provider Name (Legal Business Name): ELIZABETH GONZALEZ KEIFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 LEXINGTON AVE
MANSFIELD OH
44907-2250
US

IV. Provider business mailing address

1450 EISENHOWER AVE
MANSFIELD OH
44904-1408
US

V. Phone/Fax

Practice location:
  • Phone: 419-709-8447
  • Fax: 419-526-5525
Mailing address:
  • Phone: 419-709-8447
  • Fax: 419-526-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2504719-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: