Basic Information
Provider Information | |||||||||
NPI: | 1497150809 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BORSTAD | ||||||||
FirstName: | ALLISON | ||||||||
MiddleName: | LEANN | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW, LSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PIKAARD | ||||||||
OtherFirstName: | ALLISON | ||||||||
OtherMiddleName: | LEANN | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MSW, LSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1662 MARS AVE | ||||||||
Address2: |   | ||||||||
City: | LAKEWOOD | ||||||||
State: | OH | ||||||||
PostalCode: | 441073825 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2162823838 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 347 MIDWAY BLVD | ||||||||
Address2: | SUITE 306 | ||||||||
City: | ELYRIA | ||||||||
State: | OH | ||||||||
PostalCode: | 440359006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4403241300 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/28/2014 | ||||||||
LastUpdateDate: | 09/23/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/23/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I.1700366-SUPV | OH | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.