Provider Demographics
NPI:1023001062
Name:ROEHRS, MICHAEL S (LISW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:ROEHRS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5228
Mailing Address - Country:US
Mailing Address - Phone:419-874-8257
Mailing Address - Fax:419-874-9960
Practice Address - Street 1:975 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5228
Practice Address - Country:US
Practice Address - Phone:419-874-8257
Practice Address - Fax:419-874-9960
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0002078104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHROSW20571Medicare ID - Type Unspecified