MEDICARE: ALISHA KIRCHGESSNER 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	I.1600640	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	I.1600640	OTHER	OH	OHIO CLINICAL INDEPENDENT SOCIAL WORKER LICENSE

General Provider Information

NPI Number	:	1962945105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISHA KIRCHGESSNER LISW

Provider Business Mailing Address
First Line	:	1005 BELLEFONTAINE AVE STE 345
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-2886
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 BELLEFONTAINE AVE STE 345
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-2886
Country	:	US
Telephone Number	:	419-998-8221
Fax Number	:	419-998-8271

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

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	08/31/2022

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