Healthcare Provider Details

I. General information

NPI: 1831705870
Provider Name (Legal Business Name): ALEXANDRA MICHELLE PLOTT LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 06/05/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 ASHWOOD DR.
TIFFIN OH
44883
US

IV. Provider business mailing address

76 ASHWOOD DR
TIFFIN OH
44883-1908
US

V. Phone/Fax

Practice location:
  • Phone: 419-448-9440
  • Fax:
Mailing address:
  • Phone: 419-448-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS.2005355
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberI.2506636
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: