Healthcare Provider Details

I. General information

NPI: 1588309892
Provider Name (Legal Business Name): NICOLE SCHWAMBERGER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MANOR DR
PERRYSBURG OH
43551-3118
US

IV. Provider business mailing address

1100 SHAWNEE RD
LIMA OH
45805-3529
US

V. Phone/Fax

Practice location:
  • Phone: 419-874-0306
  • Fax: 419-874-9295
Mailing address:
  • Phone: 419-999-2010
  • Fax: 419-999-6284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2207458
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: