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General NPI Number Information
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NPI Number | 1396863023
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Entity Type | Individual
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Provider Name | ANNE WAYANT LISW
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 38039 W SPAULDING ST
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City | WILLOUGHBY
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State | OH
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Zip | 44094-6110
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Country | US
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Telephone | 216-932-5770
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Fax | 330-467-1151
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Provider Business Mailing Address
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Address Line | 4131 W STREETSBORO RD SUITE H
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City | RICHFIELD
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State | OH
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Zip | 44286-9040
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Country | US
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Telephone | 216-932-5770
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Fax | 330-467-1151
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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 | I-0000365
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License Number State | OH
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