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General NPI Number Information
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NPI Number | 1972277150
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Entity Type | Individual
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Provider Name | DESIREE D UNTCH LISW-S
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Gender | Female
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 4960 HIGBEE AVE NW STE 101
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City | CANTON
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State | OH
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Zip | 44718-2598
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Country | US
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Telephone | 330-427-4825
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Fax | 330-625-5096
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Provider Business Mailing Address
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Address Line | 6160 HILLFIELD ST NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-6414
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Country | US
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Telephone | 330-338-6607
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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.2203787-SUPV
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License Number State | OH
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