Healthcare Provider Details

I. General information

NPI: 1285116343
Provider Name (Legal Business Name): DUSTIN ERIC SMITH LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MORRISON DR
TOLEDO OH
43605-2124
US

IV. Provider business mailing address

329 N WEST ST
LIMA OH
45801-4332
US

V. Phone/Fax

Practice location:
  • Phone: 567-218-0770
  • Fax: 419-225-8878
Mailing address:
  • Phone: 419-221-3072
  • Fax: 419-481-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI2506668
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: