Healthcare Provider Details

I. General information

NPI: 1457902173
Provider Name (Legal Business Name): LAUREN EUBANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 OAK ALLEY CT STE 214
TOLEDO OH
43606-1370
US

IV. Provider business mailing address

3132 WYNNEWOOD DR
TOLEDO OH
43613-3120
US

V. Phone/Fax

Practice location:
  • Phone: 419-740-1836
  • Fax:
Mailing address:
  • Phone: 419-366-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2507335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: