Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | I0700426 | OH |
NPI | 1003099292 |
---|---|
Provider Name | Mark A Spieles |
First Address | Van Wert, OH 45891-2307 |
Second Address | Van Wert, OH 45891-2449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2007 |
Last Update Date | 11/12/2007 |