Healthcare Provider Details

I. General information

NPI: 1598438574
Provider Name (Legal Business Name): LISA A GROVE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 PINKERTON LN
ZANESVILLE OH
43701-1513
US

IV. Provider business mailing address

716 ADAIR AVE
ZANESVILLE OH
43701-2836
US

V. Phone/Fax

Practice location:
  • Phone: 740-891-9000
  • Fax: 740-891-9001
Mailing address:
  • Phone: 740-891-9000
  • Fax: 740-891-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0022466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: