Healthcare Provider Details

I. General information

NPI: 1023866308
Provider Name (Legal Business Name): SHANA SADOSKI LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 CLEGG DR
TOLEDO OH
43613-2022
US

IV. Provider business mailing address

329 N WEST ST
LIMA OH
45801-4332
US

V. Phone/Fax

Practice location:
  • Phone: 567-389-4796
  • Fax: 419-225-8878
Mailing address:
  • Phone: 419-221-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608019
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: