MEDICARE: MORGAN STIFFLER LISW-S

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	104100000X	Social Worker	S.1802591	OH
2	1041C0700X	Clinical Social Worker	I.2203882	OH

General Provider Information

NPI Number	:	1306402243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN STIFFLER LISW-S

Provider Business Mailing Address
First Line	:	1074 WINDSOR CROSSING LN
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-1574
Country	:	US
Telephone Number	:	937-570-8760
Fax Number	:

Provider Business Practice Location Address
First Line	:	1074 WINDSOR CROSSING LN
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-1574
Country	:	US
Telephone Number	:	937-570-8760
Fax Number	:

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

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	01/08/2024

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