Healthcare Provider Details

I. General information

NPI: 1144462532
Provider Name (Legal Business Name): SHERI GARDNER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 N HIGH ST
WORTHINGTON OH
43085-4056
US

IV. Provider business mailing address

778 MILL RUN DR
SUNBURY OH
43074-8563
US

V. Phone/Fax

Practice location:
  • Phone: 614-310-0902
  • Fax: 614-310-0905
Mailing address:
  • Phone: 614-313-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.00005212
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: