1497150809 NPI number — MS. ALLISON LEANN BORSTAD MSW, LSW

Table of content: MS. ALLISON LEANN BORSTAD MSW, LSW (NPI 1497150809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497150809 NPI number — MS. ALLISON LEANN BORSTAD MSW, LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORSTAD
Provider First Name:
ALLISON
Provider Middle Name:
LEANN
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:
PIKAARD
Provider Other First Name:
ALLISON
Provider Other Middle Name:
LEANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497150809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1662 MARS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-3825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-282-3838
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
347 MIDWAY BLVD
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
ELYRIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-9006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-324-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2014

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 , with the licence number:  I.1700366-SUPV , 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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