1356402341 NPI number — MS. CHELSEA LOUELLA FITZGERALD MSW, LSW

Table of content: MS. CHELSEA LOUELLA FITZGERALD MSW, LSW (NPI 1356402341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356402341 NPI number — MS. CHELSEA LOUELLA FITZGERALD MSW, LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZGERALD
Provider First Name:
CHELSEA
Provider Middle Name:
LOUELLA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356402341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1049 WESTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45601-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-773-4366
Provider Business Mailing Address Fax Number:
740-775-7855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1383 W HUNTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43138-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-385-2555
Provider Business Practice Location Address Fax Number:
740-775-7855
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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