Healthcare Provider Details

I. General information

NPI: 1629966643
Provider Name (Legal Business Name): MR. ALAN L HEMMINGWAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MADISON AVE STE 200
TOLEDO OH
43604-1230
US

IV. Provider business mailing address

500 MADISON AVE STE 200
TOLEDO OH
43604-1230
US

V. Phone/Fax

Practice location:
  • Phone: 567-312-8793
  • Fax:
Mailing address:
  • Phone: 567-312-8793
  • Fax: 567-312-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: