Healthcare Provider Details

I. General information

NPI: 1588588636
Provider Name (Legal Business Name): LORI ANNE ANDRUCH M. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 N HOLLAND SYLVANIA RD
SYLVANIA OH
43560-2116
US

IV. Provider business mailing address

907 SANDALWOOD RD W
PERRYSBURG OH
43551-3228
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-8508
  • Fax:
Mailing address:
  • Phone: 419-654-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02880
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: