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NPI Code Detail

MEDICARE: MRS. JESSICA CHARLENE CORSER LISW

MEDICARE: MRS. JESSICA CHARLENE CORSER 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 WorkerI.1440430OH

General Provider Information

NPI Number : 1528470424
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA CHARLENE CORSER LISW
Provider Business Mailing Address
First Line : 2837 SHERBROOKE RD
Second Line :
City : TOLEDO
State : OH
Zip : 43606-3746
Country : US
Telephone Number : 917-623-4119
Fax Number :
Provider Business Practice Location Address
First Line : 508 N HAWLEY ST
Second Line :
City : TOLEDO
State : OH
Zip : 43607-4476
Country : US
Telephone Number : 419-255-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2014
Last Update Date : 05/27/2014

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