Healthcare Provider Details

I. General information

NPI: 1073284782
Provider Name (Legal Business Name): NICHOLAS SAXTON LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E WASHINGTON ST STE 150
MEDINA OH
44256-3339
US

IV. Provider business mailing address

26101 COUNTRY CLUB BLVD APT 1325
NORTH OLMSTED OH
44070-4548
US

V. Phone/Fax

Practice location:
  • Phone: 330-241-4444
  • Fax:
Mailing address:
  • Phone: 440-225-2712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS.2106790
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: