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NPI Code Detail

MEDICARE: MRS. LAUREN MICHELSEN GOETZ LISW-S

MEDICARE: MRS. LAUREN MICHELSEN GOETZ 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
1104100000XSocial WorkerS 0901073OH
2104100000XSocial WorkerI.2103110OH
31041C0700XClinical Social WorkerI.2103110-SUPVOH

General Provider Information

NPI Number : 1871924688
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREN MICHELSEN GOETZ LISW-S
Provider Business Mailing Address
First Line : 3909 WOODLEY RD
Second Line :
City : TOLEDO
State : OH
Zip : 43606-1169
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 COMMERCE DR
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-5256
Country : US
Telephone Number : 419-872-2419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2013
Last Update Date : 08/02/2024

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