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General NPI Number Information
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NPI Number | 1043909260
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Entity Type | Individual
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Provider Name | NATALIA ANITA GRIMOLIZZI-FASANO MSW
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Gender | Female
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 1115 N SHOOP AVE STE 1
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City | WAUSEON
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State | OH
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Zip | 43567-1857
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Country | US
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Telephone | 419-335-6122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 146
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City | WAUSEON
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State | OH
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Zip | 43567-0146
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Country | US
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Telephone | 419-335-6122
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S.2207926
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License Number State | OH
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