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NPI Code Detail

MEDICARE: ALYSSA MARIE GERDES LSW

MEDICARE: ALYSSA MARIE GERDES 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
1104100000XSocial WorkerS1200089OH

General Provider Information

NPI Number : 1720534712
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA MARIE GERDES LSW
Provider Business Mailing Address
First Line : 10100 ELIDA RD
Second Line :
City : DELPHOS
State : OH
Zip : 45833-9056
Country : US
Telephone Number : 419-695-8010
Fax Number : 419-695-0565
Provider Business Practice Location Address
First Line : 11590 CENTURY BLVD STE 116
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-3317
Country : US
Telephone Number : 513-771-7239
Fax Number : 513-771-3878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2016
Last Update Date : 09/02/2020

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Directions to “ ALYSSA MARIE GERDES LSW” Practice Location

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