=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235510116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WHITNEY S DILLARD LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2015
-----------------------------------------------------
Last Update Date | 03/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3125 TRANSVERSE DR STE 1600
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43614-8008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-383-5695
-----------------------------------------------------
Fax | 419-383-3289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 ARLINGTON AVE # MS 1108
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43614-2595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-383-5695
-----------------------------------------------------
Fax | 419-383-3289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | S.1500345
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------