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NPI Code Detail

MEDICARE: AMY HORTON LISW

MEDICARE: AMY HORTON 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 WorkerS.1501201OH
21041C0700XClinical Social WorkerI.2203528OH

General Provider Information

NPI Number : 1346754801
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY HORTON LISW
Provider Business Mailing Address
First Line : 304 TREMONT ST
Second Line :
City : MONROE
State : MI
Zip : 48162-2640
Country : US
Telephone Number : 419-283-4662
Fax Number :
Provider Business Practice Location Address
First Line : 1219 JEFFERSON AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43604-5836
Country : US
Telephone Number : 734-731-4304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2017
Last Update Date : 07/06/2023

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