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219 S Front St Ste 301 Fremont OH 43420-3048 | |
| (419) 603-4387 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 219 S Front St Ste 301, Fremont, Ohio |
| Authorized Official Name and Position | Lindsay James (OWNER) |
| Authorized Official Contact | 4196034387 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1880 Morrison Rd Fremont OH 43420-4813 Ph: (419) 307-9662 | 219 S Front St Ste 301 Fremont OH 43420-3048 Ph: (419) 603-4387 |
| NPI Number | 1083355192 |
|---|---|
| Provider Enumeration Date | 04/05/2022 |
| Last Update Date | 02/02/2025 |
| Certification Date | 02/02/2025 |
| Medicare PECOS PAC ID | 2062958838 |
|---|---|
| Medicare Enrollment ID | O20240729003166 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083355192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Dori A Dalton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932429537 PECOS PAC ID: 3870625262 Enrollment ID: I20100721000179 |
| Provider Name | Lindsay Bowe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669128922 PECOS PAC ID: 5698211530 Enrollment ID: I20240726002564 |
| Provider Name | Samantha Trease |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750854808 PECOS PAC ID: 5092246959 Enrollment ID: I20241002001637 |
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