Healthcare Provider Details

I. General information

NPI: 1962692301
Provider Name (Legal Business Name): BEVERLY GARLICK KOCH LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ROBINWOOD AVENUE
TOLEDO OH
43620-1025
US

IV. Provider business mailing address

2400 ROBINWOOD AVENUE
TOLEDO OH
43620-1025
US

V. Phone/Fax

Practice location:
  • Phone: 419-241-2433
  • Fax: 419-241-2433
Mailing address:
  • Phone: 419-241-2433
  • Fax: 419-241-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0001725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: