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NPI Code Detail

MEDICARE: MRS. ANGELA RENEE TEALE MSW, LSW

MEDICARE: MRS. ANGELA RENEE TEALE MSW, LSW
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 WorkerRV499374OH

General Provider Information

NPI Number : 1558446344
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA RENEE TEALE MSW, LSW
Provider Business Mailing Address
First Line : 288 LIND AVE
Second Line :
City : MANSFIELD
State : OH
Zip : 44903-2142
Country : US
Telephone Number : 419-571-1708
Fax Number :
Provider Business Practice Location Address
First Line : 270 STERKEL BLVD
Second Line :
City : MANSFIELD
State : OH
Zip : 44907-1508
Country : US
Telephone Number : 419-756-1133
Fax Number : 419-756-6544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 07/08/2007

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