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General NPI Number Information
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NPI Number | 1578033098
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Entity Type | Individual
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Provider Name | JOSEPH GERARD JARDINE LISW
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Gender | Male
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 1806 MADISON AVE
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City | TOLEDO
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State | OH
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Zip | 43604-5460
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Country | US
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Telephone | 419-291-1801
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Fax |
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Provider Business Mailing Address
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Address Line | 5855 MONROE ST STE 201
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City | SYLVANIA
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State | OH
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Zip | 43560-2270
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Country | US
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Telephone | 419-291-1801
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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 | 6801065763
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.0004783-SUPV
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License Number State | OH
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