Healthcare Provider Details

I. General information

NPI: 1891190096
Provider Name (Legal Business Name): DONNA CLOSE MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6725 W CENTRAL AVE STE M PMB 335
TOLEDO OH
43617
US

IV. Provider business mailing address

6725 W CENTRAL AVE STE M PMB 335
TOLEDO OH
43617
US

V. Phone/Fax

Practice location:
  • Phone: 567-455-3606
  • Fax:
Mailing address:
  • Phone: 567-455-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0600567
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: