Healthcare Provider Details

I. General information

NPI: 1013497908
Provider Name (Legal Business Name): LISA M DROGOSZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 MARION WILLIAMSPORT RD E
MARION OH
43302-8683
US

IV. Provider business mailing address

670 MARION WILLIAMSPORT RD E
MARION OH
43302-8683
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-7040
  • Fax:
Mailing address:
  • Phone: 740-387-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5543
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: