MEDICARE: LINDSAY DEHAAS MSW, LISW-S

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	I.1901816	OH

General Provider Information

NPI Number	:	1679078737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY DEHAAS MSW, LISW-S

Provider Business Mailing Address
First Line	:	405 3RD ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44702-1167
Country	:	US
Telephone Number	:	330-479-6633
Fax Number	:	330-775-7887

Provider Business Practice Location Address
First Line	:	405 3RD ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44702-1167
Country	:	US
Telephone Number	:	330-479-6633
Fax Number	:	330-775-7887

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	03/04/2026

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