Healthcare Provider Details

I. General information

NPI: 1548747157
Provider Name (Legal Business Name): ALEX JOHN CLAUSSEN I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4293 MONROE ST
TOLEDO OH
43606-1943
US

IV. Provider business mailing address

1100 SHAWNEE RD
LIMA OH
45805-3583
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-6021
  • Fax:
Mailing address:
  • Phone: 419-999-2010
  • Fax: 419-999-6284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2303272
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC.2002528
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberE.2303272
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: