Healthcare Provider Details

I. General information

NPI: 1780391045
Provider Name (Legal Business Name): STEPHANIE A LANE MSW LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E BOALT ST
SANDUSKY OH
44870-4144
US

IV. Provider business mailing address

123 JOHNS ST APT L
WELLINGTON OH
44090-1272
US

V. Phone/Fax

Practice location:
  • Phone: 419-370-0880
  • Fax:
Mailing address:
  • Phone: 419-515-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608531
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: