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NPI Code Detail

MEDICARE: DIANN HACK LSW

MEDICARE: DIANN HACK LSW
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 WorkerS0012152OH

General Provider Information

NPI Number : 1114245347
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANN HACK LSW
Provider Business Mailing Address
First Line : 544 E WOODRUFF AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43604-5342
Country : US
Telephone Number : 419-693-0631
Fax Number : 419-936-7606
Provider Business Practice Location Address
First Line : 544 E WOODRUFF AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43604-5342
Country : US
Telephone Number : 419-693-0631
Fax Number : 419-936-7606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2010
Last Update Date : 05/12/2010

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Directions to “ DIANN HACK LSW” Practice Location

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