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NPI Code Detail

MEDICARE: HOLLY LYNN HIRSEL LISW

MEDICARE: HOLLY LYNN HIRSEL 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 WorkerI-0008318OH

General Provider Information

NPI Number : 1669424628
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY LYNN HIRSEL LISW
Provider Business Mailing Address
First Line : 12557 RAVENWOOD DR
Second Line :
City : CHARDON
State : OH
Zip : 44024-9009
Country : US
Telephone Number : 440-285-3568
Fax Number :
Provider Business Practice Location Address
First Line : 12557 RAVENWOOD DR
Second Line :
City : CHARDON
State : OH
Zip : 44024-9009
Country : US
Telephone Number : 440-285-3568
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 12/17/2025

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Directions to “ HOLLY LYNN HIRSEL LISW” Practice Location

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