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General NPI Number Information
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NPI Number | 1114893229
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Entity Type | Organization
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Legal Business Name | PATH FORWARD THERAPY
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 6359 CONSTITUTION DR
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City | FORT WAYNE
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State | IN
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Zip | 46804-1547
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Country | US
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Telephone | 419-890-5500
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Fax | 260-235-3829
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Provider Business Mailing Address
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Address Line | 6359 CONSTITUTION DR
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City | FORT WAYNE
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State | IN
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Zip | 46804-1547
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Country | US
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Telephone | 419-890-5500
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Fax | 260-235-3829
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAYLOR R NIESE
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Credential | LSW
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Telephone | 419-890-5500
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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 |
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License Number State |
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