Healthcare Provider Details

I. General information

NPI: 1780280917
Provider Name (Legal Business Name): ASHLEY MICHELLE GREEN MSWLSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9637 OH STATE 534
MIDDLEFIELD OH
44062
US

IV. Provider business mailing address

9637 OH STATE 534
MIDDLEFIELD OH
44062
US

V. Phone/Fax

Practice location:
  • Phone: 440-426-2000
  • Fax:
Mailing address:
  • Phone: 440-426-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS.1904245
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: