Healthcare Provider Details

I. General information

NPI: 1154995231
Provider Name (Legal Business Name): HAILEY THANASIU LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S BYRNE RD
TOLEDO OH
43615-6212
US

IV. Provider business mailing address

PO BOX 20068
TOLEDO OH
43610-0068
US

V. Phone/Fax

Practice location:
  • Phone: 419-531-5544
  • Fax: 419-531-5544
Mailing address:
  • Phone: 419-531-5544
  • Fax: 419-531-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1802606
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: