Healthcare Provider Details

I. General information

NPI: 1871744094
Provider Name (Legal Business Name): ANGELA MARIE GRYWALSKY BA, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 BENDEN DR
WOOSTER OH
44691-2568
US

IV. Provider business mailing address

3306 LULLABY LN
CLINTON OH
44216-9350
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-9029
  • Fax: 330-263-7251
Mailing address:
  • Phone: 330-706-0662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0500679
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: