=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053307207
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANNE KAERICHER L.I.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2005
-----------------------------------------------------
Last Update Date | 06/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6832 CONVENT BLVD
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-4805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-882-4529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8440
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43623-0440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-885-0200
-----------------------------------------------------
Fax | 419-885-0203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | I-0004496
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------