Healthcare Provider Details

I. General information

NPI: 1669336145
Provider Name (Legal Business Name): ANDRIA M WISNIEWSKI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S COY RD
OREGON OH
43616-3010
US

IV. Provider business mailing address

5565 AIRPORT HWY STE 100
TOLEDO OH
43615-7391
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-5800
  • Fax: 419-720-4444
Mailing address:
  • Phone: 419-720-5800
  • Fax: 419-720-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: