Healthcare Provider Details

I. General information

NPI: 1861235525
Provider Name (Legal Business Name): MADISON ANN FARLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 LINCOLN HWY
VAN WERT OH
45891-1877
US

IV. Provider business mailing address

1229 LINCOLN HWY
VAN WERT OH
45891-1877
US

V. Phone/Fax

Practice location:
  • Phone: 419-238-1695
  • Fax: 419-238-1007
Mailing address:
  • Phone: 419-238-1695
  • Fax: 419-238-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: