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NPI Code Detail

MEDICARE: MR. D. JEFFREY THOMAS LISW

MEDICARE: MR. D. JEFFREY THOMAS 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 WorkerI3022OH

General Provider Information

NPI Number : 1174711808
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. D. JEFFREY THOMAS LISW
Provider Business Mailing Address
First Line : 2803 AKRON RD
Second Line :
City : WOOSTER
State : OH
Zip : 44691-7904
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4440 POTH RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-1324
Country : US
Telephone Number : 614-751-9068
Fax Number : 614-751-9130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2007
Last Update Date : 10/09/2007

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