Healthcare Provider Details

I. General information

NPI: 1548797343
Provider Name (Legal Business Name): MISS JOYCE VIDALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 NEBRASKA AVE
TOLEDO OH
43607-3531
US

IV. Provider business mailing address

2447 NEBRASKA AVE
TOLEDO OH
43607-3531
US

V. Phone/Fax

Practice location:
  • Phone: 419-255-4444
  • Fax: 419-531-1596
Mailing address:
  • Phone: 419-255-4444
  • Fax: 419-531-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number130911
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: