Basic Information
| Provider Information | |||||||||
| NPI: | 1437475977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LODGE | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 22ND ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436042706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192416191 | ||||||||
| FaxNumber: | 4192555623 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 22ND ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436042706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192416191 | ||||||||
| FaxNumber: | 4192555623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2010 | ||||||||
| LastUpdateDate: | 04/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S.0901105 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.