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General NPI Number Information
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NPI Number | 1871924688
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Entity Type | Individual
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Provider Name | LAUREN MICHELSEN GOETZ LISW-S
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Gender | Female
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 800 COMMERCE DR
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City | PERRYSBURG
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State | OH
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Zip | 43551-5256
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Country | US
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Telephone | 419-872-2419
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Fax |
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Provider Business Mailing Address
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Address Line | 3909 WOODLEY RD
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City | TOLEDO
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State | OH
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Zip | 43606-1169
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Country | US
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Telephone |
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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 | S 0901073
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.2103110
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2103110-SUPV
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License Number State | OH
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