MEDICARE: LONELLE ORDWAY LCSW

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
1	1041C0700X	Clinical Social Worker	SW18012	FL

General Provider Information

NPI Number	:	1205403052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONELLE ORDWAY LCSW

Provider Business Mailing Address
First Line	:	6137 MOCKINGBIRD HILL CT
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-9504
Country	:	US
Telephone Number	:	850-499-2999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6137 MOCKINGBIRD HILL CT
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-9504
Country	:	US
Telephone Number	:	850-499-2999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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Directions to “ LONELLE ORDWAY LCSW” Practice Location

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