MEDICARE: KATIE WIEBER 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	104100000X	Social Worker	S.1000985
2	251S00000X	Community/Behavioral Health Agency
3	1041C0700X	Clinical Social Worker	I.2103067	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609323542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE WIEBER LISW

Provider Business Mailing Address
First Line	:	3100 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-2914
Country	:	US
Telephone Number	:	419-341-4362
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-2914
Country	:	US
Telephone Number	:	419-341-4362
Fax Number	:

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

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	02/01/2022

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Directions to “ KATIE WIEBER LISW” Practice Location

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