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General NPI Number Information
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NPI Number | 1023231453
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Entity Type | Individual
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Provider Name | JOHN M. SMALL L.I.S.W.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 2525 W BANCROFT ST
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City | TOLEDO
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State | OH
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Zip | 43607-1311
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Country | US
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Telephone | 419-578-2525
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Fax | 419-536-9220
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Provider Business Mailing Address
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Address Line | 2525 W BANCROFT ST
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City | TOLEDO
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State | OH
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Zip | 43607-1311
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Country | US
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Telephone | 419-578-2525
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Fax | 419-536-9220
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801071403
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I 0000611
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License Number State | OH
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