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NPI Code Detail

MEDICARE: CHRISTA M BRONNER LISW

MEDICARE: CHRISTA M BRONNER 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 WorkerI0900148OH

General Provider Information

NPI Number : 1659691251
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTA M BRONNER LISW
Provider Business Mailing Address
First Line : 1200 SYCAMORE LINE
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4029
Country : US
Telephone Number : 419-625-5269
Fax Number :
Provider Business Practice Location Address
First Line : 1200 SYCAMORE LINE
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4029
Country : US
Telephone Number : 419-625-5269
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2010
Last Update Date : 06/04/2010

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Directions to “ CHRISTA M BRONNER LISW” Practice Location

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