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NPI Code Detail

MEDICARE: JEFFREY VERNON LISW

MEDICARE: JEFFREY VERNON LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.0002804OH

General Provider Information

NPI Number : 1073471215
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY VERNON LISW
Provider Business Mailing Address
First Line : 1100 SHAWNEE RD
Second Line :
City : LIMA
State : OH
Zip : 45805-3529
Country : US
Telephone Number : 419-999-2010
Fax Number :
Provider Business Practice Location Address
First Line : 1100 SHAWNEE RD
Second Line :
City : LIMA
State : OH
Zip : 45805-3529
Country : US
Telephone Number : 419-999-2010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ JEFFREY VERNON LISW” Practice Location

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