MEDICARE: LYNNE M ROUTSONG-WIECHERS MSW, 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	I8167	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000297240	OTHER	OH	ANTHEM BC/BS

General Provider Information

NPI Number	:	1659453165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNE M ROUTSONG-WIECHERS MSW, LISW

Provider Business Mailing Address
First Line	:	8940 KINGSRIDGE DR
Second Line	:	STE 106
City	:	DAYTON
State	:	OH
Zip	:	45458-1632
Country	:	US
Telephone Number	:	937-432-9130
Fax Number	:	937-432-9169

Provider Business Practice Location Address
First Line	:	8940 KINGSRIDGE DR
Second Line	:	STE 106
City	:	DAYTON
State	:	OH
Zip	:	45458-1632
Country	:	US
Telephone Number	:	937-432-9130
Fax Number	:	937-432-9169

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/30/2020

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