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NPI Code Detail

MEDICARE: MRS. LACEY MICHELLE WESCHE LISW

MEDICARE: MRS. LACEY MICHELLE WESCHE 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
1101YM0800XMental Health CounselorI 1201500OH

General Provider Information

NPI Number : 1871639377
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LACEY MICHELLE WESCHE LISW
Provider Business Mailing Address
First Line : 203 PROMENADE DR
Second Line :
City : SWANTON
State : OH
Zip : 43558-1428
Country : US
Telephone Number : 419-874-0274
Fax Number : 419-874-9960
Provider Business Practice Location Address
First Line : 424 W WOODRUFF AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43604-5027
Country : US
Telephone Number : 419-841-7701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 04/20/2018

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