MEDICARE: MS. ANGELA HENDREN 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
1	1041C0700X	Clinical Social Worker	10029870	OH

General Provider Information

NPI Number	:	1861435158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA HENDREN LISW

Provider Business Mailing Address
First Line	:	7540 NEW WEST RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-4200
Country	:	US
Telephone Number	:	866-203-0308
Fax Number	:

Provider Business Practice Location Address
First Line	:	7540 NEW WEST RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617
Country	:	US
Telephone Number	:	866-203-0308
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	12/03/2018

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