Provider Demographics
NPI:1023539798
Name:TRAVISS, MONICA HELEN (LISW)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:HELEN
Last Name:TRAVISS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:SPITLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:8448 KEITHA DR
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9638
Mailing Address - Country:US
Mailing Address - Phone:734-648-5821
Mailing Address - Fax:
Practice Address - Street 1:830 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1884
Practice Address - Country:US
Practice Address - Phone:419-214-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099303104100000X
OHI.21030041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker