Healthcare Provider Details

I. General information

NPI: 1598271215
Provider Name (Legal Business Name): LINDSAY GREGORIN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 W CENTRAL AVE
TOLEDO OH
43606-2929
US

IV. Provider business mailing address

209 W POE RD
BOWLING GREEN OH
43402-1767
US

V. Phone/Fax

Practice location:
  • Phone: 567-316-7253
  • Fax:
Mailing address:
  • Phone: 567-316-7253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1201263
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2304783
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: