Provider Demographics
NPI:1164648788
Name:KEPFORD, MICHELLE M (LSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:KEPFORD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-3403
Mailing Address - Country:US
Mailing Address - Phone:419-478-3037
Mailing Address - Fax:419-478-1671
Practice Address - Street 1:5331 BENNETT RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-3403
Practice Address - Country:US
Practice Address - Phone:419-478-3037
Practice Address - Fax:419-478-1671
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 0018698104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1437626587OtherANCHORED IN HOPE COUNSELING, LLC. GROUP NPI
OH0275683Medicaid