Healthcare Provider Details

I. General information

NPI: 1053855817
Provider Name (Legal Business Name): WENDY STARLIN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 PANTHER DR NE
NEW LEXINGTON OH
43764-9081
US

IV. Provider business mailing address

1049 WESTERN AVE P.O. BOX 188
CHILLICOTHEE OH
45601-1104
US

V. Phone/Fax

Practice location:
  • Phone: 740-342-4192
  • Fax: 740-775-7855
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-775-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1600311
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: