MEDICARE: ANDRIA M WISNIEWSKI 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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1669336145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRIA M WISNIEWSKI LSW

Provider Business Mailing Address
First Line	:	5565 AIRPORT HWY STE 100
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-7391
Country	:	US
Telephone Number	:	419-720-5800
Fax Number	:	419-720-4444

Provider Business Practice Location Address
First Line	:	715 S COY RD
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3010
Country	:	US
Telephone Number	:	419-720-5800
Fax Number	:	419-720-4444

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ ANDRIA M WISNIEWSKI LSW” Practice Location

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