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NPI Code Detail

MEDICARE: ANDREA JO'LEA DAVIS LSW

MEDICARE: ANDREA JO'LEA DAVIS 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 WorkerI.2002177OH

General Provider Information

NPI Number : 1114418282
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA JO'LEA DAVIS LSW
Provider Business Mailing Address
First Line : 2602 NEBRASKA AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43607-3241
Country : US
Telephone Number : 419-318-9121
Fax Number :
Provider Business Practice Location Address
First Line : 2602 NEBRASKA AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43607-3241
Country : US
Telephone Number : 419-318-9121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2018
Last Update Date : 04/02/2025

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