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General NPI Number Information
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NPI Number | 1801525159
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Entity Type | Individual
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Provider Name | ABIGAIL ANNE MERRY LISW
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 1025 CENTER ST
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City | ASHLAND
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State | OH
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Zip | 44805-4011
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Country | US
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Telephone | 419-207-2463
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Fax | 419-289-0391
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Provider Business Mailing Address
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Address Line | 644 COURTWRIGHT BLVD
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City | MANSFIELD
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State | OH
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Zip | 44907-2218
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Country | US
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Telephone | 419-631-7118
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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 | I.2002142
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License Number State | OH
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