MEDICARE: WILLIAM GINGERICH 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
1	1041C0700X	Clinical Social Worker	I.0900068	OH

General Provider Information

NPI Number	:	1598999385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM GINGERICH LISW

Provider Business Mailing Address
First Line	:	221 FOUNTAIN PL
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-2205
Country	:	US
Telephone Number	:	937-593-9600
Fax Number	:	937-592-7705

Provider Business Practice Location Address
First Line	:	8200 STATE ROUTE 366
Second Line	:	STE 2B
City	:	RUSSELLS POINT
State	:	OH
Zip	:	43348-9670
Country	:	US
Telephone Number	:	937-589-3330
Fax Number	:	815-346-4059

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

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	12/05/2019

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