Provider Demographics
NPI:1013222652
Name:PANT, DOREEN MICHELLE (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:MICHELLE
Last Name:PANT
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3335 MEIJER DR
Mailing Address - Street 2:SUITE #450
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-3104
Mailing Address - Country:US
Mailing Address - Phone:419-467-6361
Mailing Address - Fax:419-671-8026
Practice Address - Street 1:3335 MEIJER DR
Practice Address - Street 2:SUITE #450
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-3104
Practice Address - Country:US
Practice Address - Phone:419-467-6361
Practice Address - Fax:419-671-8026
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00085331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPASW22101Medicare Oscar/Certification