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General NPI Number Information
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NPI Number | 1669695235
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Entity Type | Individual
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Provider Name | CHRISTOPHER MICHAEL STREIDL LISW
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 3000 ARLINGTON AVE MAIL STOP 1161
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City | TOLEDO
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State | OH
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Zip | 43614-2595
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Country | US
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Telephone | 419-383-3521
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Fax | 419-383-3277
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Provider Business Mailing Address
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Address Line | P.O. BOX 95 207 W MAIN STREET
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City | PORTAGE
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State | OH
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Zip | 43451
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Country | US
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Telephone | 419-704-0769
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S0031093
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License Number State | OH
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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-0800108
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License Number State | OH
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