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General NPI Number Information
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NPI Number | 1851841787
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Entity Type | Individual
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Provider Name | MICHELLE LAVER LISW-S
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Gender | Female
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 23095 KELLOGG RD
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City | GRAND RAPIDS
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State | OH
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Zip | 43522-9727
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Country | US
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Telephone | 419-966-8380
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Fax |
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Provider Business Mailing Address
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Address Line | 7320 SH 108
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City | WAUSEON
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State | OH
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Zip | 43537
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Country | US
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Telephone | 419-335-3732
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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.1901424-SUPV
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License Number State | OH
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